Abstract
BackgroundCentral arterial stiffness has been shown to play a key role in cardiovascular disease. However, evidence regarding such arterial stiffness from various arterial segments in relation to B-type natriuretic peptide (BNP) remains elusive.MethodsA total of 1255 participants (47.8% men; mean age: 62.6 ± 12.3 [SD] years) with preserved left ventricular function (ejection fraction ≥50%) and ≥1 risk factors were consecutively studied. Arterial pulse wave velocity (PWV) by automatic device (VP-2000; Omron Healthcare) for heart-femoral (hf-PWV), brachial-ankle (ba-PWV), and heart-carotid (hc-PWV) segments were obtained and related to BNP concentrations (Abbott Diagnostics, Abbott Park, IL, USA).ResultsSubjects in the highest hf-PWV quartile were older and had worse renal function and higher blood pressure (all P < 0.05). Elevated PWV (m/s) was correlated with elevated BNP (pg/ml) (beta coefficient = 19.3, 12.4, 5.9 for hf-PWV, ba-PWV, hc-PWV respectively, all p < 0.05). After accounting for clinical co-variates and left ventricle mass index (LVMI), both hf-PWV and ba-PWV were correlated with higher BNP (beta coefficient = 8.3, 6.4 respectively, P < 0.01 for each). Adding both hf-PWV and ba-PWV to LVMI significantly expanded ROC in predicting abnormal BNP>100 pg/ml (both P < 0.01), but only hf-PWV presented significant integrated discrimination improvement to predict risk for BNP concentrations (0.7%, P = 0.029).ConclusionA significant segmental PWV associated with biomarker BNP concentrations suggests that arterial stiffness is associated with myocardial damage.
Highlights
After accounting for clinical co-variates and left ventricle mass index (LVMI), both hf-pulse wave velocity (PWV) and brachial-ankle pulse wave velocity (ba-PWV) were correlated with higher B-type natriuretic peptide (BNP)
Adding both hf-PWV and ba-PWV to LVMI significantly expanded receiver operating characteristic (ROC) in predicting abnormal BNP>100 pg/ml, but only hf-PWV presented significant integrated discrimination improvement to predict risk for BNP concentrations (0.7%, P = 0.029)
Cardiac dysfunction can be caused by several factors including arterial stiffness, systemic inflammation, accumulation of adiposity, and vascular-ventricular overload, and uncoupling. [18,19,20] Tartiere et al reported that the central aortic arterial stiffness marker carotid-femoral pulse wave velocity (cf-PWV) is an independent prognostic factor for HFpEF, [21] and Yambe et al further demonstrated that higher peripheral muscular arterial stiffness is linked to elevated BNP concentration in patients with hypertension.[15]
Summary
Heart failure continues to be a major and growing public health issue and remains the leading cause of hospitalization; it is associated with an approximately 45% post-discharge mortality and readmission rate within 3 months.[1,2] Despite treatment using pharmacologic and mechanical (device) interventions, the clinical outcome of patients with preserved ejection fraction heart failure (HFpEF) remains suboptimal[3], with a hospitalization rate and poor prognosis[4,5,6] as malignant as systolic dysfunction heart failure (HFrEF, median survival: 2.1 years). [7] B-type natriuretic peptide (BNP) is a reliable biomarker for diagnosing heart failure and has demonstrated predictive value for hospitalization and mortality both in HFpEF and HFrEF. [8,9]Pulse pressure (PP) has emerged as a predictor for heart failure in the elderly population. [10,11] Greater afterload from increased arterial stiffness has been shown to be the key pathophysiology in subjects with known hypertension in the elderly population for diminished arterial compliance, which may cause cardiac dysfunction and contribute to elevated BNP level[12,13,14]. [18,19,20] Tartiere et al reported that the central aortic arterial stiffness marker cf-PWV is an independent prognostic factor for HFpEF, [21] and Yambe et al further demonstrated that higher peripheral muscular arterial stiffness (ba-PWV) is linked to elevated BNP concentration in patients with hypertension.[15] In the current study, we investigated an intermediate- to high-risk population with preserved EF function to determine the relations among PWV of different arterial segments (central aortic and peripheral muscular) and circulating BNP levels, a clinical surrogate of potential myocardial damage. Central arterial stiffness has been shown to play a key role in cardiovascular disease Evidence regarding such arterial stiffness from various arterial segments in relation to B-type natriuretic peptide (BNP) remains elusive
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