Inflection point of ascending aortic waveform is a predictive factor for all-cause and cardiovascular mortality in patients with chronic renal failure on hemodialysis

BACKGROUND: The reflection waveform in the ascending aortic pressure has been reported to reflect systemic arterial stiffness, and increase risk of coronary heart disease. The purpose of this study is to evaluate prospectively whether the reflection waveform in the ascending aortic pressure is associated with the mortality in patients with chronic renal failure on hemodialysis. METHODS: Fifty two patients with chronic renal failure on hemodialysis and undergoing cardiac catheterizations were enrolled in this study. Inflection time was measured to determine the reflection waveform in the ascending aortic pressure at angiography. Inflection time was defined as the time interval from initiation of a systolic pressure waveform to the inflection point. RESULTS: The mean duration of follow-up was 55 +/- 49 months (mean +/- SD). Mean age at entry was 58.5 +/- 9.0 years. We confirmed 14 cardiovascular deaths, and 5 non-cardiovascular deaths. Shorter inflection time increased all-cause and cardiovascular mortality. Kaplan-Meier analysis demonstrated a significantly reduced survival ratio in patients with inflection time < or =87 msec (all-cause death; P < 0.01, cardiovascular death; P < 0.001 by log-rank test). Multiple-adjusted hazard ratio for 10 msec decrease in inflection time was 1.49 (95% confidence interval, 1.07 to 2.08) for all-cause mortality, and was 4.66 (95% confidence interval, 1.82 to 11.95) for cardiovascular mortality. CONCLUSION: Shorter inflection time increased all-cause and cardiovascular mortality in patients with chronic renal failure on hemodialysis.