Abstract 11892: Novel Measures of Arterial Stiffness and Wave Reflections Associate With Clinical Outcomes in Patients With Heart Failure

Abstract

Introduction: Arterial stiffness and earlier wave reflections can increase afterload and impair cardiovascular function. Most prior studies have been performed in patients with preserved left ventricular (LV) function. Hypothesis: Novel measures of pulsatile arterial hemodynamics are predictive of worse clinical outcomes in patients with HFrEF. Methods: Patients with HFrEF (N=137, median age 56, 49% female, 58% Black) and age-matched healthy controls (N=124) underwent measurements of large artery stiffness and pulsatile arterial hemodynamics from 2015-2019 at a single study visit. Carotid-femoral pulse wave velocity (CF-PWV) and augmentation index (AIx) were assessed using high-fidelity applanation tonometry. In HFrEF patients, pressure-flow analyses were performed to derive aortic characteristic impedance (QZc), reflected wave transit time (RWTT), and wasted pressure effort (WPE). In HFrEF patients, Cox proportional hazards models examined associations between vascular function measures and 1) all-cause death and 2) a combined endpoint of left ventricular assist device (LVAD) implant, heart transplant (HT), and death at 2 years adjusted for race, BNP, and MAGGIC risk score. Results: Compared to controls, patients with HFrEF had similar CF-PWV (6.8+/-1.6 v. 7.0+/-1.6 m/s, P=0.4), and higher AIx normalized to a HR of 75 bpm (13+/-2% v. 22+/-2%, P<0.001). Among HFrEF patients, a shorter RWTT was associated with death (adjusted hazard ratio [aHR] 0.60, 95% confidence interval [CI] 0.37-0.97) and the combined endpoint of death/LVAD/HT (aHR 0.62, 95% CI 0.41-0.94) at 2 years ( Figure ). WPE/QZc, which represents the proportion of systolic load from wave reflection, was associated with the combined endpoint on multivariable analysis (aHR 1.40, 95% CI 1.02-1.93). AIx and PWV were not predictive of clinical outcomes. Conclusion: Increased LV systolic load from premature wave reflections is associated with adverse clinical outcomes in patients with HFrEF.