Association of Pressure Wave Reflections With Left Ventricular Mass: a Systematic Review and Meta-Analysis


 
 Pressure wave reflections (PWRs) within the circulation are assessed at various arterial sites by various noninvasive methods. We aimed at reviewing the conflicting data regarding the hypothesis that higher PWRs are associated with higher left ventricular mass and tested whether this association stands for all available indices of PWRs, all (proximal or distal to the heart) sites of assessment, and is modified by sex, age and heart rate.
 
 
 
 Based on a predefined protocol applying the MOOSE guidelines, we identified eligible for meta-analysis data regarding: augmentation index, augmentation pressure, backward pressure (Pb), reflection index, and their association with left ventricular mass index (19 studies, total population n=8686).
 
 
 
 
 We found significant associations, independent from blood pressure level, for all indices of PWRs at all arterial sites (carotid augmentation index; odds ratio, 0.14 [95% CI, 0.07%–0.21%], per SD increase), radial augmentation index (0.21; 0.11–0.31), central augmentation pressure (0.15; 0.03–0.27), central Pb (0.23; 0.05–0.42), and central reflection index (0.14; 0.06–0.22), expect for aortic augmentation index as estimated by generalized transfer functions. Meta-regression analysis showed that the association between carotid augmentation index and left ventricular mass was higher among populations with higher heart rate (
 P
 =0.036, beta: 0.017 [CI, 0.001–0.033]) and tended to be higher in middle-aged (
 P
 =0.07, −0.001; −0.021 to 0.001).
 
 
 
 
 A clinically meaningful association between PWRs and left ventricular mass, assessed in either central or peripheral arterial sites by most available methods was shown, suggesting that PWR reduction strategies might be useful. Based on the present evidence, such trials should target middle-aged populations with high normal heart rate.
