Heart-Ankle Pulse Wave Velocity Is Superior to Brachial-Ankle Pulse Wave Velocity in Detecting Aldosterone-Induced Arterial Stiffness

Round 1

Reviewer 1 Report

Scientific publication is written clearly and intelligibly in its field.

I have small notes:

There are multiple phrases "With regards to" in the text, I might recommend with regard to (as I said that I am not an expert in EL, I do not request the adjustment)

Figure 1 and Table 1,2,3 should contain the abbreviations used in the given tables, as in Figure 2

The method of data evaluation based on Propensity score matching of age and sex and Propensity score matching of age, sex, systolic and diastolic blood pressure is an interesting finding. Question: why were the groups not compared with each other, as this could speak of sensitivity or clarity in clinical practice for immediate use by doctor - in conclusion, in addition to pointing out better use of haPWV, there could be a recommendation.

To the figure and the results of figure2: it is not defined in the publication whether the ROC is evaluated in AUC as an area under the average curve, or the AUC is calculated from each patient and then the average is made. At the same time, Tables 2 and 3 do not have an SD, although it is a physical quantity that has been evaluated from several data. Or it is data in parentheses, but then it is necessary to describe it in the appropriate figure, as it is not clear what the values are.

 

Thanks and I wish you much success in other publications

Author Response

We would like to express our thanks to all of the reviewers for their helpful questions and suggestions. The comments of the reviewers have been addressed point by point in the letter. Modifications have been marked using “track change” in the revised version. The annotated Line number in the reply was based on the “track change” version. Besides, we also provided the manuscript and table without “tracking” in the end of pdf file to make it easier to read!

 

Sincerely Yours,

Austin Yen-Hung Lin M.D., Ph.D., FESC

Clinical Professor of Medicine

Department of Internal Medicine (Cardiology)

National Taiwan University Hospital

President

Taiwan Society of Aldosteronism

Head of the Cardiovascular Research Team

TAIPAI Study Group

Author Response File: Author Response.pdf

Reviewer 2 Report

Authors examined baPWV and haPWV for PA and EH patients enrolled in TAIPAI study using propensity score matching method. Both baPWV and haPWV were high in PA patients compared to EH patients. Using ROC curve analysis, they showed haPWV is more sensitive than baPWV. This is interesting study, but there were some questions to be clarified.

 

Page 3, line 84; authors stated all patients were registered in TAIPAI database. In the reference (30), patients with coding (255.1) in reimbursement records were extracted from NHI records. Does algorithm of TAIPAI database was still same in this protocol? If so, patients with EH in this cohort were once diagnosed or suspected as PA in local center. How do authors think appropriateness of extract method of EH patients?

 

Page 3, line 93; is diagnosis timing and collection of PWV measurement was same? If so, ACEI, ARB, beta blocker, spironolactone and diuretics were discontinued for 21 days and confirmation test and PWVs were performed? In table 1, spironolactone was used for more PA patients than for EH patients, therefore, I assumed that PA diagnosis has already done in some extent proportion of this cohort. I am afraid that this cohort is heterogeneous for diagnosis timing and PA-specific treatment period. I suggest authors classified with regard to the timing of PWV measurement such as “diagnosis timing”, “follow-up after intervention of PA-specific treatment”.

 

Page 3, line 100; please provide the approved number from review board.

 

Table 1; please provide the proportion of APA and IHA in PA cohort. How is the difference of PWV data between APA and IHA groups? If diagnosis of APA is difficult to collect, the existence of adrenal mass should be used instead of diagnosis of APA.

It should be noted that there was a significant difference between hypertension history. As arterial stiffness is affected by hypertension history, propensity score matching of hypertension history should be checked. Or, multivariate analysis in PSM1 and 2 should be tried to examine whether hypertension history is a confounding factor or not.

PWV data comparison between groups with or without MR blocker treatment to assess the usefulness of PA-specific treatment is meaningful and should be shown.

Author Response

We would like to express our thanks to all of the reviewers for their helpful questions and suggestions. The comments of the reviewers have been addressed point by point in the letter. Modifications have been marked using “track change” in the revised version. The annotated Line number in the reply was based on the “track change” version. Besides, we also provided the manuscript and table without “tracking” in the end of pdf file to make it easier to read!

 

 

Sincerely Yours,

Austin Yen-Hung Lin M.D., Ph.D., FESC

Clinical Professor of Medicine

Department of Internal Medicine (Cardiology)

National Taiwan University Hospital

President

Taiwan Society of Aldosteronism

Head of the Cardiovascular Research Team

TAIPAI Study Group

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report

Authors responded my questions appropriately, however there are some suggestions.

 

Regarding my question about Table 1, authors provided “Table. Area under the ROC curve (AUC) between baPWV and haPWV.” I understood that authors showed the superiority of haPWV even if hypertension history was considered. I would like to know whether there still remains significant difference between PA vs EH in PSM including hypertension history. I recommend authors to mention PSM including hypertension history in the results or discussion, even if authors do not show the data.

 

Authors added the sentence: “Third, there were 20% PA and 4% EH patients already using spironolactone. This might theoretically lessen the difference between PA and EH patients. However, it was unlikely to change the results in this study.” I recommend that authors provide the reason of this comment. As authors calculated the comparison between with or without spironolactone, authors can explain why treatment with spironolactone does not affect their conclusion.

Author Response

We would like to express our thanks to all of the reviewers for their helpful questions and suggestions. The comments of the reviewers have been addressed point by point in the letter. Modifications have been marked using “track change” in the revised version. The annotated Line number in the reply was based on the “track change” version. Besides, we also provided the manuscript and table without “tracking” in the end of pdf file to make it easier to read!

Sincerely Yours,

Austin Yen-Hung Lin M.D., Ph.D., FESC

Clinical Professor of Medicine

Department of Internal Medicine (Cardiology)

National Taiwan University Hospital

President

Taiwan Society of Aldosteronism

Head of the Cardiovascular Research Team

TAIPAI Study Group

Author Response File: Author Response.pdf