Clinical Investigation
Heart Failure
Increased Aortic Pulse Wave Velocity as Measured by Echocardiography Is Strongly Associated with Poor Prognosis in Patients with Heart Failure

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Background

An increased aortic pulse wave velocity (PWV), a marker of arterial stiffness, is associated with poor prognosis in various diseases. In patients with heart failure (HF), an increased aortic PWV is associated with low peak exercise oxygen consumption, which is a strong risk factor of adverse clinical outcomes. However, it remains unknown if an increased aortic PWV predicts poor prognosis in patients with HF, independent of peak exercise oxygen consumption.

Methods and Results

We enrolled 156 patients with HF and left ventricular ejection fraction <45%, who were followed up for a mean (SD) period of 36 ± 19 months. At baseline, all the patients underwent a complete echocardiography with aortic PWV as measured by Doppler ultrasonography and peak exercise oxygen consumption as measured by bicycle exercise testing with expiratory gas exchange monitoring. During the follow-up period, 20 patients (12.8%) died and 15 patients (9.6%) were hospitalized for worsening HF. In the Kaplan-Meier analysis, patients in the first tertile of aortic PWV had a lower risk of developing cardiac death or hospitalization (combined end point) than those in the second and third tertile combined (P < .001). In Cox regression analysis, increased aortic PWV (both as a continuous and categorical variable) was significantly associated with an increased risk of adverse clinical outcomes after adjustment for peak exercise oxygen consumption and other clinical risk factors (P < .05).

Conclusions

Increased aortic PWV, as measured by echocardiography, independently predicted adverse clinical outcomes (cardiac death or hospitalization) among patients with HF.

Section snippets

Patients

We prospectively studied a sample of 156 outpatients (129 men; mean age, 65 years) with diagnosed HF, who regularly attended the HF clinic of the cardiology division at the University Hospital of Verona. Each patient had a diagnosis of HF, which was based on the presence of LV systolic dysfunction (i.e., LV ejection fraction < 45% and end-diastolic LV volume > 90 mL/m2). Inclusion criteria of the study were stable clinical conditions for at least 6 months and the presence of optimal medical

Results

During a follow-up period of 5 years (mean [SD] follow-up period of 36 ± 19 months), there were 20 cardiac deaths and 15 hospitalizations for worsening HF. Three patients received nonurgent cardiac transplantation, and, accordingly, they were censored as alive at the date of surgery. No patients died from noncardiac causes during the follow-up period. The baseline characteristics of patients with HF grouped according to the occurrence of any clinical events at follow-up are summarized in Table 1

Discussion

To our knowledge, this prospective, observational study is the first to specifically address the value of aortic PWV in predicting adverse clinical outcomes in patients with HF. The major finding of this “real-world” study is that increased aortic PWV, as measured by conventional echocardiography, was strongly associated with an increased risk of cardiac death and hospitalization (combined end point) in a sample of outpatients with HF who were followed up for a period of 5 years. Interestingly,

Conclusions

The results of this study provide the first evidence, to our knowledge, that echocardiographically derived aortic PWV is a strong predictor of adverse clinical outcomes (cardiac death or hospitalization) in patients with systolic HF. Aortic PWV allows us also to identify a subgroup of patients with HF and with more distensible aortas who bear a better prognosis, which suggests that more preserved large elastic artery properties could play a role in slowing the progression of HF also in those

References (43)

  • H. Asanoi et al.

    Ventriculoarterial coupling in normal and failing heart in humans

    Circ Res

    (1989)
  • G.F. Mitchell et al.

    Pulsatile hemodynamics in congestive heart failure

    Hypertension

    (2001)
  • J.M.O. Arnold et al.

    Large artery function in patients with chronic heart failure

    Circulation

    (1991)
  • J.D. Carroll et al.

    Arterial mechanical properties in dilated cardiomyopathy. Aging and the response to nitroprusside

    J Clin Invest

    (1991)
  • N. Westerhof et al.

    Haemodynamic basis for the development of left ventricular failure in systolic hypertension and for its logical therapy

    J Hypertens

    (1995)
  • S. Bonapace et al.

    Aortic distensibility independently affects exercise tolerance in patients with dilated cardiomyopathy

    Circulation

    (2003)
  • W.G. Hundley et al.

    Cardiac cycle-dependent changes in aortic area and distensibility are reduced in older patients with isolated diastolic heart failure and correlate with exercise intolerance

    J Am Coll Cardiol

    (2001)
  • K. Weber et al.

    Oxygen utilization and ventilation during exercise in patients with chronic cardiac failure

    Circulation

    (1982)
  • J.N. Cohn et al.

    Ejection fraction, peak exercise oxygen consumption, cardiothoracic ratio, ventricular arrhythmias, and plasma norepinephrine as determinants of prognosis in heart failure. The V-HeFT VA Cooperative Studies Group

    Circulation

    (1993)
  • W.W. Nichols et al.

    Vascular impedance

  • A.P. Avolio et al.

    Effects of aging on changing arterial compliance and left ventricular load in a northern Chinese urban community

    Circulation

    (1983)
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