Abstract
Abstract Objective: Micro- and macrovascular changes can occur in heart failure, and could influence its prognosis and management. In a prospective study, we proposed the evaluation of arterial stiffness (macrovascular function) and its correlations in patients with systolic heart failure. Methods: 40 patients (32 men, 8 women, mean age 63±2.9 years), with hemodynamically stable systolic heart failure (left ventricular ejection fraction, EF<40%) were enrolled in the study. In every patient, beyond routine explorations (ECG, cardiac and carotid ultrasound, laboratory measurements), arterial stiffness was assessed by measuring pulse wave velocity (PWV). The correlations of PWV with clinical and echo-cardiographic characteristics were studied using t-test and chi-square test (p<0.05 being considered for statistical significance). Results: The average PWV was 8.55±2.2 m/s, and 16 patients had increased PWV (>10 m/s). We found significantly higher PWV values in patients older than 65 years (p<0.001), in patients with eGFR <60 ml/min/1.73 m2 (p<0.001), hypertension (p=0.006), and increased (>1 mm) carotid intima-media thickness (p=0.016). PWV was found to be significantly lower when EF was <30% (p=0.049). Furthermore, the presence of an increased PWV was correlated significantly with age (p<0.001), and (with borderline significance) with eGFR <60 ml/min/1.73 m2 and, inversely, with EF<30%. Conclusions: Increased arterial stiffness reflected by high PWV is frequently present in patients with systolic heart failure, and is mainly correlated with general risk factors of arterial involvement. Low EF, due to low stroke volume and decreased systolic arterial wall tension can influence the values and the interpretation of PWV.
Highlights
Heart failure (HF) is a result of cardiac structural and/or functional abnormalities, which determine low cardiac output and high filling pressures, responsible for clinical picture, consisted mainly of dyspnea, fatigue and signs of congestion
The Pulse wave velocity (PWV) proved to be significantly higher in patients with age >65 years, eGFR
The development of increased arterial stiffness is related to arteriosclerosis, a process which is driven by endothelial dysfunction (ED) and vascular ageing [12]
Summary
Heart failure (HF) is a result of cardiac structural and/or functional abnormalities, which determine low cardiac output and high filling pressures, responsible for clinical picture, consisted mainly of dyspnea, fatigue and signs of congestion. Involves central and peripheral mechanisms as well [1]. Arterial function, both its micro- and macrovascular component, has become a target for evaluation and therapy in many pathological conditions, including HF, vascular dysfunction having a well-known or putative role in cardiovascular disease mechanisms. Pulse wave velocity (PWV) has emerged in the last decades as a potent marker of arterial stiffness, a key element of macrovascular arterial dysfunction. PWV has proven to be a stable and reproductible parameter, and its increase has prognostic significance in many cardiovascular and non-cardiovascular conditions, like hypertension, coronary heart disease and chronic kidney disease [2, 3]. Due to the commercially available, validated devices, the measurement of PWV has become reliable in the everyday practice [4]
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