Prognostic significance of the timing in the cardiac cycle of the first (TP1) and second (TP2) systolic peak of the central aortic pulse wave is ill-defined. Incidence rates and standardized multivariable-adjusted hazard ratios (HRs) of adverse health outcomes associated with TP1 and TP2, estimated by the SphygmoCor software, were assessed in the International Database of Central Arterial Properties for Risk Stratification (IDCARS) (n = 5529). Model refinement was assessed by the integrated discrimination (ID) and net reclassification (NR) improvement. Over 4.1 years (median), 201 participants died and 248 and 159 patients experienced cardiovascular or cardiac endpoints. Mean TP1 and TP2, standardized for cohort, sex, age, and heart rate, were 103 and 228 ms. Shorter TP1 and TP2 were associated with higher mortality and shorter TP1 with a higher risk of cardiovascular and cardiac endpoints (trend p ≤ 0.004). The HRs relating total mortality and cardiovascular endpoints to TP2 were 0.82 (95% confidence interval [CI]: 0.72-0.94) and 0.87 (0.77-0.98), respectively. The HR relating cardiac endpoints to TP1 was 0.81 (0.68-0.97). For total mortality and cardiovascular endpoints in relation to TP2, NRI was significant (p ≤ 0.010), but not for cardiac endpoints in relation to TP1. Integrated discrimination improvement (IDI) was not significant for any endpoint. The HRs relating total mortality to TP2 were smaller (p ≤ 0.026) in women than men (0.67 vs. 0.95) and in older (≥ 60 years) versus younger (< 60 years) participants (0.80 vs. 0.88). Our study adds to the evidence supporting risk stratification based on aortic pulse analysis by showing that TP2 and TP1 carry prognostic information.

1st Department of Cardiology Interventional Electrocardiology and Hypertension Jagiellonian University Medical College Kraków Poland

Biomedical Sciences Group Faculty of Medicine University of Leuven Leuven Belgium

Centro de Nefrología and Departamento de Fisiopatología Hospital de Clínicas Universidad de la República Montevideo Uruguay

Department of Cardiology Shanghai General Hospital Shanghai China

Department of Cardiology the 1st Affiliated Hospital of Sun Yat Sen University Guangzhou Guangdong China

Department of Cardiovascular Medicine Shanghai Key Laboratory of Hypertension Shanghai Institute of Hypertension State Key Laboratory of Medical Genomics National Research Centre for Translational Medicine Ruijin Hospital Shanghai Jiaotong University School of Medicine Shanghai China

Department of Chronic Disease Prevention Finnish Institute for Health and Welfare Turku Finland

Department of Medicine Turku University Hospital and University of Turku Turku Finland

Department of Medicine University of Padua Padua Italy

Faculty of Medicine Charles University Pilsen Czech Republic

Hypertension Unit Department of Hypertension and Diabetology Medical University of Gdańsk Gdańsk Poland

Non Profit Research Association Alliance for the Promotion of Preventive Medicine Leuven Belgium

Research Institute Alliance for the Promotion of Preventive Medicine Mechelen Belgium

Research Unit Environment and Health Department of Public Health and Primary Care University of Leuven Leuven Belgium

Servicio de Clínica Médica Sección Hipertensión Arterial Hospital Italiano de Buenos Aires Buenos Aires Argentina

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