PREDICTIVE VALUE OF ESTIMATED PULSE WAVE VELOCITY FOR ALL-CAUSE AND CARDIOVASCULAR MORTALITY, AND NON-FATAL CARDIOVASCULAR OUTCOMES - A LONGITUDINAL FOLLOW-UP ENAH STUDY

Objective: This study aimed to evaluate the predictive value of estimated pulse wave velocity (ePWV) for mortality and cardiovascular (CV) outcomes in a longitudinal study of a rural population with limited access to healthcare. Design and method: A total of 1175 participants from the ENAH rural project in Croatia were followed-up for an average of 136.0 months (100.0-163.8) over the period from 2005 to 2022, to assess the relationship between ePWV and mortality or CV events. Mortality data were collected from the National Institute for Public Health, and data for morbidity from the medical records of local physicians. ePWV was calculated using a validated equation. Results: A total of 264 deaths (22.5%) were recorded, while 171 participants (14.5%) experienced at least one non-fatal event, including myocardial infarction, atrial fibrillation, heart failure, stroke, transient ischemic attack, or dialysis. Participants with ePWV >10 m/s had significantly higher overall mortality compared to those with ePWV <10 m/s (49.2% vs. 5.2%; p<0.001). CV mortality was higher in the ePWV >10 m/s group compared to the lower ePWV group (48% vs. 18.9%; p=0.002). Kaplan Meier analysis (KMa) revealed significantly lower survival rates in the group with ePWV >10 m/s compared to the group with ePWV <10 m/s (HR=12.8, 95% CI 9.9-16.6, p<0.001) (Figure 1A). Similarly, KMa indicated a reduced survival rate to non-fatal outcomes in the ePWV >10 m/s group compared to the ePWV <10 m/s group (HR=1.50, 95% CI 1.0-2.1, p=0.008) (Figure 1B). For composite fatal and non-fatal outcomes, the hazard ratio for participants with ePWV >10 m/s was 4.14 (95% CI 3.36-5.12; p<0.001) (Figure 1C). Multivariate analysis revealed ePWV as a strong independent predictor of mortality (HR=1.81; 95% CI 1.08-3.04; p=0.030). Conclusions: Elevated ePWV is associated with significantly higher mortality and CV related deaths. ePWV could be an important and useful tool in rural settings with limited access to healthcare, where direct measurement of PWV is not available. The implementation of ePWV in routine clinical assessments may help identify high-risk patients and guide early intervention strategies.