Association of worsening arterial stiffness with incident heart failure in asymptomatic patients with cardiovascular risk factors

• Published in: Hypertension research Vol. 40; no. 2; pp. 173 - 180
• Main Authors: Aisu, Hiroe, Saito, Makoto, Inaba, Shinji, Morofuji, Toru, Takahashi, Kayo, Sumimoto, Takumi, Okura, Takafumi, Higaki, Jitsuo
• Format: Journal Article
• Language: English
• Published: England Nature Publishing Group 01-02-2017
• Subjects: Adult; Aged; Aged, 80 and over; Ankle Brachial Index; Asymptomatic; Cardiovascular Diseases - diagnostic imaging; Cardiovascular Diseases - physiopathology; Echocardiography; Female; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - epidemiology; Heart Failure - physiopathology; Hospitalization; Humans; Hypertension; Incidence; Male; Middle Aged; Pulse Wave Analysis; Retrospective Studies; Risk Factors; Vascular Stiffness - physiology; Ventricular Function, Left - physiology
• ISSN: 0916-9636; 1348-4214
• DOI: 10.1038/hr.2016.116

We investigated the independent and incremental role of worsening arterial stiffness in new-onset heart failure (HF) in patients with preclinical HF. We retrospectively studied 456 consecutive asymptomatic patients with HF risk factors (hypertension, obesity, type 2 diabetes mellitus, atrial fibrillation and ischemic heart disease) who underwent paired applanation tonometry examinations (median interval of 2.4 years) during 2006-2011. Brachial ankle pulse wave velocity (baPWV) was measured as a surrogate marker of arterial stiffness. Patients were followed up for admission for new-onset HF over a median duration of 4.9 years after the second examination. HF was observed in 30 patients (7%). The change in baPWV (∆baPWV) was significantly associated with hospitalization for new-onset HF, independent of and incremental to comorbidities, renal dysfunction, left ventricular (LV) dysfunction and baPWV at baseline. Even in patients with an LV ejection fraction of ⩾40%, ∆baPWV was significantly associated with hospitalization for new-onset HF after similar adjustments. When the patients were divided into groups based on this cutoff value of ⩾15% ∆baPWV and the generally accepted external cutoff value of ⩾1750 cm s
for baseline baPWV, the Kaplan-Meier estimates of the time of hospitalization for new-onset HF showed that a higher rate of HF was associated with higher baPWV at baseline and higher ∆baPWV (P=0.00005). In asymptomatic patients with cardiovascular risk factors, the deterioration in arterial stiffness was associated with hospitalization for new-onset HF, independent of and incremental with the clinical LV function and increased stiffness parameters at baseline.