Vascular aging detected by peripheral endothelial dysfunction is associated with ecg-derived physiological aging

Takumi Toya, Ali Ahmad, Zachi Attia, Michal Cohen-Shelly, Ilke Ozcan, Peter A. Noseworthy, Francisco Lopez-Jimenez, Suraj Kapa, Lilach O. Lerman, Paul A. Friedman, Amir Lerman

Research output: Contribution to journalArticlepeer-review

Abstract

BACKGROUND: An artificial intelligence algorithm that detects age using the 12-lead ECG has been suggested to signal “physi-ologic age.” This study aimed to investigate the association of peripheral microvascular endothelial function (PMEF) as an index of vascular aging, with accelerated physiologic aging gauged by ECG-derived artificial intelligence–estimated age. METHODS AND RESULTS: This study included 531 patients who underwent ECG and a noninvasive PMEF assessment using reactive hyperemia peripheral arterial tonometry. Abnormal PMEF was defined as reactive hyperemia peripheral arterial tonometry index ≤2.0. Accelerated or delayed physiologic aging was calculated by the Δ age (ECG-derived artificial intelligence– estimated age minus chronological age), and the association between Δ age and PMEF as well as its impact on composite major adverse cardiovascular events were investigated. Δ age was higher in patients with abnormal PMEF than in patients with normal PMEF (2.3±7.8 versus 0.5±7.7 years; P=0.01). Reactive hyperemia peripheral arterial tonometry index was negatively associated with Δ age after adjustment for cardiovascular risk factors (standardized β coefficient, –0.08; P=0.048). The highest quartile of Δ age was associated with an increased risk of major adverse cardiovascular events compared with the first quartile of Δ age in patients with abnormal PMEF, even after adjustment for cardiovascular risk factors (hazard ratio, 4.72; 95% CI, 1.24–17.91; P=0.02). CONCLUSIONS: Vascular aging detected by endothelial function is associated with accelerated physiologic aging, as assessed by the artificial intelligence–ECG Δ age. Patients with endothelial dysfunction and the highest quartile of accelerated physiologic aging have a marked increase in risk for cardiovascular events.

Original languageEnglish (US)
Article numbere018656
Pages (from-to)1-15
Number of pages15
JournalJournal of the American Heart Association
Volume10
Issue number3
DOIs
StatePublished - 2021

Keywords

  • Artificial intelligence
  • Peripheral microvascular endothelial dysfunction
  • Physiological age
  • Reactive hyperemia peripheral arterial tonometry index
  • Vascular age

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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