廣野, 明 徳島大学大学院医科学教育部（医学専攻）
Kageyama, Norihito Tokushima Prefectural Miyoshi Hospital
Sumitomo, Masayuki Tokushima Prefectural Miyoshi Hospital
Fujinaga, Hiroyuki Tokushima Prefectural Central Hospital
Inter-arm systolic blood pressure difference
optimal cut-off value
ankle-brachial blood pressure index
Background: An inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors.
Methods: From 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality.
Results: During a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, p = 0.005). The receiver operating characteristic curve revealed that 5 mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p < 0.001). In the validation cohort, the presence of a large IAD (IAD ≥ 5 mmHg) was significantly associated with the primary endpoint (p = 0.021).
Conclusions: IAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5 mmHg.
Journal of Cardiology
Japanese College of Cardiology|Elsevier
本論文は, 著者Akira Hironoの学位論文として提出され, 学位審査・授与の対象となっている。
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