Abstract
Background: Cardiovascular remodeling is a recognized chronic kidney disease (CKD) complication. The clinical implication of heart failure with mildly reduced ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) in CKD, including their underlying pathogenic mechanisms, remains incompletely understood. Objectives: This study aimed to determine the association between arterial stiffness, as measured by the cardio-ankle vascular index (CAVI), and impaired interaction between the left ventricle and the arterial system by ventricular-arterial coupling (VAC) determined by echocardiography with heart failure with HFmrEF or HFpEF in non-dialysis CKD. Secondly, to evaluate the prognostic impact of baseline HFmrEF/HFpEF, abnormal CAVI, and VAC on long-term outcomes. Methods: A cross-sectional and prospective analysis was conducted in the CORE-CKD cohort of 66 non-dialysis CKD patients, stages 3-5. The relationship between CAVI or VAC and HFmrEF/HFpEF at baseline was assessed using multivariate logistic regression. Subsequently, the association between HFmrEF/HFpEF, high CAVI, and high VAC with a composite outcome of all-cause mortality and cardiovascular hospitalization was evaluated using the multivariate Cox proportional hazards model. Results: At baseline, those with HFmrEF/HFpEF (n=18) had significantly higher CAVI (9.4 vs. 8.4, p=0.001) and VAC values (1.02 vs. 0.88, p=0.033) than those without HFmrEF/HFpEF. High CAVI was significantly associated with HFmrEF/HFpEF by multivariate analysis (OR 5.11, 95% CI: 1.27-20.42). This prospective study showed that the median follow-up time was six years. The risk for primary composite outcome was substantially higher in patients with HFmrEF/HFpEF than those without (HR 43.8, 95%CI: 5.89-304.8). Conclusion: HFmrEF/HFpEF was associated with increased arterial stiffness, impaired left ventricular-arterial coupling, and a significantly elevated risk of mortality or cardiovascular hospitalization among CKD patients.
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