Investigation on Cardiovascular Risk Prediction Using Physiological Parameters

Table 3

Established and potential physiological risk factors used for prediction of cardiovascular diseases.

Physiological; parameters	Predictors	Significance and limitations		Predictive; power
BP
Resting BP	Usual BP; Visit-to-visit BPV; Maximum BP	Measures the brachial artery cuff blood pressure. Strong risk factors for CV prediction. Cuffless and continuous monitoring are under improvement.		+++++
ABPM	Daytime BP mean; Nighttime BP; 24-h mean BP; Night-to-day BP ratio; Night BPV; Day BPV; 24-hour BPV	Measures the ambulatory blood pressure fluctuation. Provides additional important information over clinic blood pressure. Elevated night-time BP is a better predictor of cardiovascular risk than clinic BP, 24-hour BP means or daytime BP means. The predictive values of reading-to-reading BPV still remain low and conflicting.		++++; +
Stress BP	Sub maximal BP; Maximal BP; Recovery BP after exercise	Provide additional prognostic information in CV prediction beyond normal rest blood pressure. The results remain controversial depending on different exercise BP indexes adopted.		++; +; ++
ECG
Resting ECG	Resting heart rate; LVH; ST segment depression; Negative T wave; Pathological Q-wave; LBBB; Arrhythmias; Prolonged QRS duration; QT interval prolongation; Major and minor abnormalities; ECG strain pattern; Ischemic ECG findings; Composite ECG score	Measures the electrical activity of the heart and relates to short-term risk of CVD. Resting heart rate is a strong, graded, and independent risk factor. Repolarization abnormalities in combination with LVH show great prediction value. Noncontact wireless ECG sensors based on capacitively coupled principle are becoming washable and can be integrated in clothing or wearable accessories for unobtrusive monitoring.		++++
Ambulatory ECG	Nighttime heart rate; Night-to-day heart rate ratio; HRV	The prediction value of ambulatory heart rate remains low and somewhat controversial. HRV measures the vagal and sympathetic modulation of the sinus node.		++; +
Stress ECG	Exercise-induced ST-segment depression; Chronotropic incompetence; Reduced heart rate recovery; Exercise-induced abnormalities; Composite ECG score; Exercise capacity; Duke treadmill score; Nomogram-illustrated model	Provide additional prognostic information beyond normal resting ECG. Chronotropic incompetence, reduced heart rate recovery, and exercise capacity are proved to be strong predictors. The predictive values of others remain low. Heart rate recovery is still limited by the variable recovery protocols and variable criteria for abnormality.		+++
Arterial Stiffness
Aortic PWV	cfPWV	Clinical gold standard for assessing aortic stiffness.	Pressure dependent, without information of the wave reflection and other artery geometry information. Inaccurate measurement of the distance.	+++
	baPWV	Widely used in large scale trials for its convenience measurement.		++
Pulse wave analysis	AIx; Central SBP; PP; Reflected wave magnitude; AASI	Offering wave reflection information. Indirect indicator of arterial stiffness.		++
Blood glucose	Diabetes mellitus; Impaired fasting glucose; Impaired glucose tolerance; Combined IFG & IGT	Strong, graded, and independent predictors. Technical advances in noninvasive and continuous glucose monitoring are under development.		++++; +; ++; +++
ABI	ABI < 0.9; ABI > 1.4	Indicating the presence of peripheral artery disease; Indicating calcified arteries		++++; ++++

BP: blood pressure; CV: cardiovascular; ABPM: ambulatory blood pressure monitoring; BPV: blood pressure variability; ECG: electrocardiogram; LVH: left ventricular hypertrophy; CVD: cardiovascular disease; LBBB: left bundle branch blocks; HRV: heart rate variability; cfPWV: carotid femoral pulse wave velocity; baPWV: brachial-ankle pulse wave velocity; Aix: aortic augmentation index; SBP: systolic blood pressure; PP: pulse pressure; AASI: ambulatory arterial stiffness index; ABI: ankle-brachial blood pressure index; IFG: impaired fasting glucose; IGT: impaired glucose tolerance.