Association Of Cardio-ankle Vascular Index Research Articles

Hypertension-specific association of cardio-ankle vascular index with subclinical left ventricular function in a Chinese population: Danyang study.

The association of cardio-ankle vascular index (CAVI), with subclinical cardiac dysfunction in hypertensive patients is unclear. We aim to examine their relationship in hypertensive patients compared with that in normotensive subjects. Our study included 1887 subjects enrolled from Danyang between 2018 and 2019. CAVI was measured using VaSera VS-1500A device. We performed conventional echocardiography to measure ejection fraction (EF) and E/A, tissue Doppler to measure mitral annular early diastolic velocities (e'), and speckle-tracking to estimate left ventricular (LV) global longitudinal strain (GLS). LV mass index (76.3, 80.0, and 84.0g/m2), and E/e' (7.6, 8.2, and 8.8) were increased and GLS (21.1, 21.0, and 20.4%), E/A (1.2, 1.0, and 0.8) and e' velocity (11.2, 9.4, and 8.2cm/s) was decreased from tertiles 1-3 of CAVI on unadjusted analyses (P<.001). After adjustment for covariates, GLS, E/A, and e' were still significantly decreased from tertiles 1-3 of CAVI (P ≤.04). Further sensitive analyses revealed a similar association pattern for diastolic function but not systolic function. Compared with the lowest tertile, subjects with a top tertile of CAVI were at higher risk of subclinical LV systolic dysfunction in hypertensive patients (OR=2.61; P=.005). Increased CAVI is associated with worse subclinical diastolic function. However, this relationship of CAVI to subclinical systolic function was more prominent in hypertensive patients.

Association of Sleep Duration and Cardio-Ankle Vascular Index in Community-Dwelling Older Adults.

This study aims to investigate the association of the Cardio-Ankle Vascular Index (CAVI) with self-reported sleep duration and sleep quality in community-dwelling older adults aged ≥ 65 years. The Tarumizu Study was a cohort of community-based health checkups conducted in the Tarumizu City, Japan, in 2018 and 2019. In total, 997 participants aged ≥ 65 years (median age, 74 years) were examined. We obtained the average sleep duration and sleep quality using self-reported questionnaires and classified them into three separate groups according to sleep duration (＜6 h, 6-8 h, and ≥ 8 h) and sleep quality (good, medium, and poor). The arterial stiffness was measured using the CAVI. As per our findings, the CAVI was significantly higher in the ≥ 8 h sleep group (CAVI=9.6±1.3) than in the ＜6 h (CAVI=9.1±1.1) or 6-8 h (CAVI=9.1±1.2) groups (p＜0.001). After adjustment for age, sex, systolic blood pressure, current smoking status, body mass index, frequency of exercise, educational background, frailty, sleep medication, sleep quality, and nap duration, multivariable regression analysis demonstrated that the CAVI was significantly higher in the ≥ 8 h group than in the 6-8 h group (p=0.016). In contrast, multivariable regression analysis showed that there was no significant association between sleep quality and CAVI. A significant association was noted between long sleep duration (≥ 8 h) and elevated CAVI in community-dwelling older adults aged ≥ 65 years. We, therefore, suggest that long sleep duration, not sleep quality, is correlated with arterial stiffness in older adults.

Association of cardio-ankle vascular index and future major adverse cardiovascular events in older adults living with HIV

ABSTRACT Increased arterial stiffness is an indicator of cardiovascular disease (CVD) and death in the general population. The cardio-ankle vascular index (CAVI) is a novel method for measuring arterial stiffness. This study investigated the utility of CAVI as a prognostic indicator of CVD and death in older adults living with HIV(OALHIV). Patients aged ≥50 taking antiretroviral treatment with no history of cardiovascular events enrolled from multiple centers in Chiang Mai, Thailand. Participants (N = 347) who underwent CAVI were followed up for five years. The primary endpoint was major adverse cardiovascular events (MACE): a composite of total deaths and hospitalizations due to myocardial infarction, coronary revascularization, stroke, and heart failure. Cox regression analysis determined between normal (<8) and high (≥8) CAVI against the incidence of MACE. Forty-five participants (13.0%) were diagnosed with MACE. The risk of MACE was more significant in high CAVI than normal CAVI (adjusted HR = 2.11, 95% confidence interval 1.06–4.20, p = 0.033). In OALHIV, CAVI was an independent prognosis of MACE, in addition to conventional CVD risk factors. CAVI-assisted to help identify high-risk patients showed the benefit of further evaluation and more intensive therapy to prevent CVD and death.

Association of Cardio-Ankle Vascular Index (CAVI) and Duration of Diabetes Mellitus in the STOP (Semaglutide Treatment on Coronary Plaque Progression) Randomized Control Trial

IntroductionCardio‐ankle vascular index(CAVI) is a novel index that measures arterial stiffness noninvasively. Recent studies demonstrated CAVI to be a predictor for coronary artery disease(CAD). Patients with Type-2 diabetes mellitus(DM) develop arterial stiffening which contributes to the CAD complications associated with DM. However, a comprehensive assessment of the association of CAVI and DM has not been reported. MethodsThe STOP trial randomized patients with DM and presence of coronary plaque on CCTA to Semaglutide 1mg once weekly or placebo. CAVI was measured using the VaSera(Fukuda Denshi, Tokyo, Japan). Non-invasive blood pressure, Pulse Wave Velocity and Heart Sound Measuring were integrated to compute CAVI. Multivariate linear regression was used to examine the association of baseline CAVI and duration of diabetes. ResultsIn 98 randomized STOP subjects, mean age was 56.8±8.3 yrs and 60 (61%) were male. Of these, 81 (83%) had hyperlipidemia, 81 (83%) had hypertension, 13 (13%) were current-smokers, and 31 (32%) were former-smokers. The mean duration of DM was 16.3±7.5 yrs. In an unadjusted linear regression analysis, there was a positive linear relationship between duration of DM and CAVI (p=0.036). However, upon further analysis with adjustment for age, gender, body mass index, HLD, HTN, and past smoking, the association was no longer significant (p=0.189). ConclusionCAVI has a linear association with the duration of Diabetes. The lack of statistical significance on multivariate adjusted analysis could be due to the small sample size. Future studies should assess the prognostic role of CAVI in patients with DM.

Assessment of Arterial Stiffness Using the Cardio-Ankle Vascular Index – What We Know and What We Strive for

Currently, the importance of assessing arterial stiffness as an integral indicator of cardiovascular risk, an indicator of arteriosclerosis, and a predictor of cardiovascular events has been demonstrated. The traditional indicator of arterial stiffness-pulse wave velocity-depends on the level of blood pressure, which makes it difficult to use it for dynamic assessment. The proposed new arterial stiffness index-the cardio-ankle vascular index (CAVI), does not depend on the level of blood pressure and is more convenient in practical use. CAVI has been widely used in clinical medicine for the past 15 years as an index for assessing cardiovascular diseases and risk factors, which has allowed for the expansion and deepening of research on this topic. This review focuses primarily on recent publications and new opportunities for evaluating vascular function using CAVI. The review provides information on solving methodological problems in evaluating CAVI, highlights the relationship between CAVI and future cardiovascular events, and provides cross-sectional data on the Association of CAVI with the presence of cardiovascular diseases and their risk factors. The results of studies on the effect of drug therapy and measures to control risk factors for cardiovascular diseases on CAVI are presented. While it remains unclear how much changes in CAVI over time can affect the forecast, research is currently being conducted in this direction. The use of CAVI also opens up new perspectives in the assessment of cardiovascular interactions, the study of vascular function in vasculitis and vascular injuries, as well as in geriatric medicine (concepts of premature vascular aging and excess vascular aging).

The Association of Cardio-Ankle Vascular Index and Ankle-Brachial Index in Patients with Peripheral Arterial Disease

Introduction: The cardio-ankle vascular index (CAVI) is a well-known index to evaluate arterial stiffness and predict cardiovascular risk. Methods: We investigated whether CAVI can predict severity and extent of peripheral arterial disease. This study was a single-center, retrospective, observational study approved by the Ethics Committee of Yokohama Shintoshi Neurosurgical Hospital. A total of 96 patients (males, 63) with an abnormal ankle-brachial blood pressure index (ABI) of <0.9 and who underwent extremity arteriography at our hospital from 2015 to 2018 were enrolled in this study. We defined that CAVI with a range of <8.0 was normal. Results: Coronary angiography and extremity arteriography were performed for patients who had intermittent claudication and abnormal ABI. We divided the affected limbs into 3 categories: above-the-knee artery stenosis, above-the-knee artery chronic total occlusion, and only below-the-knee artery stenosis/occlusion groups. CAVI pseudonormalization was seen in 28, 76, and 19%, respectively. The above-the-knee artery stenosis and the only below-the-knee artery stenosis/occlusion groups had a high odds ratio of abnormalization of CAVI (3.1, 95% confidence interval [CI]: 1.39–7.22; p = 0.05, 4.56, 95% CI: 1.64–14.7). Discussion/Conclusion: In the presence of the above-the-knee artery chronic total occlusion, CAVI pseudonormalization was likely to be seen. The presence of CTO in the above-the-knee artery is one cause of pseudonormalized CAVI. In the range of ABI, in which stenotic lesions and obstructive lesions coexist, it may be possible to detect the existence of CTO by a combination of both ABI and CAVI.

The Association of Cardio-Ankle Vascular Index (CAVI) with Biatrial Remodeling in Atrial Fibrillation.

Aim: Arterial stiffness results in elevated left ventricular filling pressure and can promote atrial remodeling due to chronic pressure overload. However, the impact of arterial stiffness on the process of atrial remodeling in association with atrial fibrillation (AF) has not been fully evaluated. Methods: We enrolled 237 consecutive patients diagnosed with AF who had undergone ablation; data from 213 patients were analyzed. Cardio-ankle vascular index (CAVI) was used as a marker of arterial stiffness. The left atrial (LA) and right atrial (RA) volumes were determined by computed tomography imaging; atrial conduction and voltage amplitude were evaluated using a three-dimensional electromapping system used to guide the ablation procedure. Result: In univariate analysis, CAVI significantly correlated with atrial structural and electrical remodeling (LA volume index, r =0.297, P =0.001; RA volume index, r =0.252, P =0.004; LA conduction velocity, r =0.254, P = 0.003; LA mean voltage, r =−0.343, P =0.001, RA mean voltage; r =−0.245, P =0.015). Multivariate regression analysis revealed that CAVI and plasma levels of N-terminal B-type natriuretic peptide were independent determinants of LA and RA remodeling, respectively. On the other hand, age and LA conduction velocity were independent variables with respect to CAVI. Age-adjusted CAVI was highest in long-standing persistent AF when compared with measures of persistent or paroxysmal AF. Conclusion: CAVI was closely associated with biatrial remodeling in patients diagnosed with AF. These results suggest that arterial stiffness may play a significant role with respect to disease progression.

Difference in positive relation between cardio-ankle vascular index (CAVI) and each of four blood pressure indices in real-world Japanese population.

This study aimed to investigate the association of cardio-ankle vascular index (CAVI), an arterial stiffness parameter, with four blood pressure (BP) indices, systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) and mean BP (MBP), in real-world population including untreated hypertension. We analyzed the cross-sectional data from 23,257 Japanese subjects (12,729 men and 10,528 women, aged 47.1 years) without a past history of cardiovascular disease, stroke, hypertension, diabetes or dyslipidemia. Gender differences in four BP indices were slight, but significant for SBP, DBP and MBP. All four BP indices increased linearly with age. After adjusting for confounders comprising gender, age, HDL-C and BMI identified by multiple regression analysis, CAVI was lower in normotensive subjects compared to hypertensive subjects. Trend test detected an almost linear relation of adjusted CAVI with each of four BP indices even within ideal range. Exceptionally, the increment in adjusted CAVI reached its peak over 140 mm Hg range in SBP. Logistic regression models showed that 1-SD increment in each BP index contributed independently to high CAVI (≥90th percentile), whereas that in PP showed a somewhat lower contribution. Subgroup analyses revealed that older age, dyslipidemia and hypertension were independently associated with relatively small contributions to high CAVI per 1-SD increment in SBP. PP might be less useful to assess arterial stiffness compared to other BP indices. Besides, the contribution of SBP increment to arterial stiffening was relatively large in normotensive, normolipidemic non-elderly subjects, whose individual transition of SBP should be noticed.

The Association of Cardio-Ankle Vascular Index and Ankle-Brachial Index with Macroangiopathy in Patients with Type 2 Diabetes Mellitus.

Aims: This study elucidates the association of macroangiopathy development in type 2 diabetes patients with various arteriosclerosis risk factors (ARFs) and results of cardio-ankle vascular index (CAVI) and ankle-brachial pressure index (ABI).Methods: The correlation between current and past macroangiopathy development, with ARFs or CAVI/ABI data, was retrospectively analyzed using multivariate logistic regression in 816 patients with type 2 diabetes at a single center. C-statistics combining some independent variables selected using the stepwise method were evaluated.Results: CAVI was significantly correlated with macroangiopathies, including coronary artery disease (CAD), arteriosclerosis obliterans (ASO), and stroke with odds ratios (OR) of 1.20, 1.22, and 1.19, respectively. ABI significantly correlated with ASO and stroke with respective OR of 13.6 and 2.47, but not with CAD. Areas under the receiver operating characteristic curves (ROCs) revealed the accuracy of detecting ASO and stroke was increased by the combination of CAVI + ABI (0.94 and 0.74, respectively). However, areas under the ROC for the presence of CAD can be increased by the combination of CAVI and ARFs especially including dyslipidemia.Conclusion: CAVI/ABI and some ARFs are useful tools in daily clinical care units to identify the current and past existence of macroangiopathy in patients with type 2 diabetes, but the prediction weights using these factors were different among CAD, ASO, and stroke.

Association of cardio-ankle vascular index with cardiovascular risk factors and cardiovascular events in metabolic syndrome patients

ObjectivesWe aimed to investigate the association between arterial stiffness assessed as cardio-ankle vascular index (CAVI) and cardiovascular (CV) risk factors and CV events in the middle-aged metabolic syndrome (MS) patients. Materials and methodsA follow-up study was carried out in 2106 middle-aged (53.83±6.17 years old, 62% women) MS subjects without overt atherosclerotic disease. Patients were initially recruited in 2009–2011 as participants of the Lithuanian High Cardiovascular Risk (LitHiR) primary prevention program and followed up for 3.8±1.7 years for CV events. Thorough cardiometabolic risk assessment was carried out at inclusion. ResultsSubjects with higher CAVI had worse lipid and glucose metabolism profile: elevated total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), decreased high-density lipoprotein cholesterol (HDL-C), higher fasting and oral glucose tolerance test (OGTT) glucose levels (all P<0.001), and lower fasting insulin (P=0.021). Greater age (P<0.001), heart rate (P=0.016), and mean arterial pressure (P<0.001) were also associated with higher CAVI. Over the follow-up period, 93 (4.4%) patients developed a cardiovascular event: 55 (2.6%) patients had myocardial infarction and 38 (1.8%) suffered a cerebrovascular event. Fatal CV events comprised 6.5% (n=6) of all CV events. CAVI was statistically significantly associated with occurrence of myocardial infarction (P=0.027) and total cardiovascular events (P=0.045), but not cerebrovascular events (P=0.65). However, this association was dependent on age and gender. ConclusionsIn the middle-aged MS patients, higher CAVI was associated with altered lipid and glucose metabolism, older age, greater heart rate and mean arterial pressure, and worse cardiovascular outcome.

Association of cardio-ankle vascular index with diastolic heart function in hypertensive patients

Arterial stiffness is an important risk factor of impaired left ventricular (LV) diastolic function as well as systolic dysfunction. The cardio-ankle vascular index (CAVI) and the ambulatory arterial stiffness index (AASI) can evaluate arteriosclerosis. We analyzed the relationship between arterial stiffness and diastolic function, and then compared the two methodologies to assess which method could serve as a more informative tool for diastology. In total, 136 patients with hypertension underwent 24-h ambulatory blood pressure monitoring (ABPM) and echocardiography including ventricular arterial coupling (VAC). Arterial stiffness was estimated using both CAVI and AASI derived from ABPM. Patients were classified into LV diastolic dysfunction and normal function groups. Those with diastolic dysfunction had a higher CAVI and AASI. Aside from LV torsion, mitral inflow parameters, tissue Doppler velocities and VAC showed a significantly greater association with CAVI, relative to AASI. The receiver operating characteristic curve analysis revealed that CAVI [area under the curve (AUC) = 0.869, p < 0.001] provided significantly more favorable accuracy for diastolic dysfunction compared with AASI (AUC = 0.672, p = 0.004). Multiple logistic regression analyses showed that CAVI [Odds ratio (OR) = 5.1, p = 0.009] had a greater association with diastolic dysfunction, relative to age, systolic blood pressure or AASI (OR = 1.4, p = 0.043). This study indicates that CAVI clinically provides diastolic functional information much better in hypertensive patients than AASI.

Association of Cardio-Ankle Vascular Index with Brain Natriuretic Peptide Levels in Hypertension

Plasma brain natriuteric peptide (BNP) is an established marker of cardiovascular events in individuals without heart failure. Although the cardio-ankle vascular index (CAVI) is clinically used as a parameter of arterial stiffness, its usefulness for predicting cardiovascular events has not been fully examined. This study aimed to evaluate the association among CAVIs, plasma BNP levels and left ventricular (LV) hypertrophy and dysfunction in hypertensive patients. We enrolled 136 hypertensive patients (69±10 years) who had been taking antihypertensive medications for at least one year. Echocardiography was performed to evaluate LV hypertrophy and function. Plasma BNP levels and CAVIs were also measured simultaneously. CAVI was correlated with plasma BNP (r =0.245, p =0.004). Multiple linear regression analysis revealed three independent determinants of CAVI: age (β =0.568, p <0.001), diameter of ascending aorta (β =0.289, p <0.001), and diabetes (β =0.207, p =0.003). In addition, multiple linear regression analysis revealed two independent determinants of the plasma BNP level: left atrial diameter (β =0.334, p <0.001) and CAVI (β =0.256, p =0.002). The present study indicates that increased CAVI is independently associated with elevated plasma BNP produced by increased LV afterload, that is, arterial stiffness, in hypertensive patients. Moreover, the present study raises the possibility that CAVI may be as useful as the plasma BNP level for predicting the risk of cardiovascular events in hypertensive patients.

Association of cardio-ankle vascular index with physical fitness and cognitive symptoms in aging Finnish firefighters

Monitoring cardiovascular risk factors is important in health promotion among firefighters. The assessment of arterial stiffness (AS) may help to detect early signs of atherosclerosis. The aim of this study was to analyze associations between aerobic fitness, cognitive symptoms and cardio-ankle vascular index (CAVI) as a measure for AS among Finnish firefighters. The data are one part of a large 13-year follow-up study of the health and physical and mental capacity of Finnish professional firefighters. The subjects in this substudy comprised 65 male firefighters of a mean age of 48.0 (42-58) years in 2009. Their maximal oxygen uptake was successfully measured in two cross-sectional studies in 1996 and 2009, and they responded to questionnaires at both sessions, and their CAVI was measured in 2009. CAVI was calculated from the pulse waveform signal and pulse wave velocity. The lifestyle habits and subjective cognitive stress-related symptoms were collected via a standardized questionnaire. Muscular fitness was measured by the routine test battery used for Finnish firefighters. CAVI was related to age. About one-fifth of the firefighters had a CAVI of >8. Aerobic fitness was the main physiological factor correlating with increased CAVI. Interestingly, VO(2)max and the accelerated decrease in VO(2)max during a 13-year follow-up were associated with signs of impaired vascular function. The cognitive symptoms derived from the Profile of Mood States questionnaire (POMS) were mainly associated with stress and sleeping difficulties. No clear association with physical fitness was found in this population of fit firefighters. Among firefighters, the decrease in aerobic fitness predicts increased arterial stiffness. The speed of the age-related decline in maximal oxygen consumption is as important as absolute level. Against expectations, the cognitive function did not correlate with vascular health parameters. The cognitive symptoms, however, were only mild.

Association of Cardio-Ankle Vascular Index with Cardiovascular Disease Risk Factors and Coronary Heart Disease among Japanese Urban Workers and their Families

Purpose: Recently the cardio-ankle vascular index (CAVI) has been developed to represent the extent of arteriosclerosis in the artery from the aortic valve to the ankle. The aim of the study is to examine the association of CAVI scores with the established cardiovascular disease (CVD) risk factors and coronary heart disease (CHD). Methods: Subjects were 9,881 men and 12,033 women of company employees and their families between 20 and 70 years of age and over who participated in CVD screening in Japan. The screening included measurements of CAVI, electrocardiogram, blood pressure, lipids, serum glucose, hemoglobin A1c, height, weight, and questions on smoking and drinking status. Persons having CHD were defined as those having history of CHD and/or having abnormal Q wave and/or ischemic change in ECG. After converting CAVI scores to binary variables (normal or abnormally high CAVI scores), logistic regression analysis was conducted. Results: After adjusting for age, significant odds ratios (ORs) of abnormally high CAVI scores among men were found with diabetes mellitus (10.02, p<0.001), hypertension (8.37, p<0.001), triglycerides (2.76, p<0.001, for 150-199mg/dL and 2.85, p<0.001, for ≥200mg/dL, as reference:<150mg/dL), high density lipoprotein cholesterol (0.19, p<0.001, for 40-59mg/dL and 0.20, p<0.001 for ≥60mg/dL, as reference: <40mg/dL), body mass index (2.04, p<0.001, for <20, 2.31, p<0.001, for 28-29.9 and 3.37, p<0.001, for ≥30 as reference:20-22.9), and ex-smokers (1.20, p<0.01, as reference: non-smokers). Almost identical results were found among women, except a significant OR with current smokers (2.25, p<0.001). The significant association between CHD and abnormally high CAVI scores was found: OR=3.87, p<0.001 for men and 1.45, p<0.01 for women after adjusting for CVD risk factors. Conclusions: Our results confirmed that CAVI scores are a reliable indicator of arteriosclerosis reflecting the extent of arterial stiffness and atherosclerosis in the major artery between the aortic valve and the ankle.

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A new indicator of arterial stiffness, cardio-ankle vascular index (CAVI), has recently been developed, instead of conventional pulse wave velocity. CAVI is proposed as a blood pressure-independent indicator of atherosclerosis, however, there have been few studies on the association of CAVI with atherosclerosis. The purpose of this study was to investigate effects of age on the relationship between CAVI and atherosclerotic risk in patients with diabetes mellitus. The relationship between CAVI and atherosclerotic risk was investigated in 105 subjects with type 2 diabetes mellitus (mean age, 65.1 years old). The mean intima-media thickness (IMT) of the carotid artery was used as an indicator of atherosclerotic progression. In 55.2% of the subjects, CAVI was abnormally high (> or =9.0). In simple regression analysis, CAVI showed significant correlations with age, duration of diabetes and IMT. In logistic regression analysis, crude odds of abnormally high values of CAVI were significant for highest versus lowest tertile groups of mean arterial pressure (MAP) and IMT. Age-and sex-adjusted odds of abnormally high values of CAVI were significant for highest versus lowest tertile groups of mean arterial pressure (MAP) and serum total cholesterol. In multiple regression analysis, CAVI showed significant correlation with IMT independently of MAP but not independently of age, while the significant correlation of ankle-brachial pressure index (ABPI) with IMT was independent of age, sex and MAP. CAVI reflects atherosclerotic risk and the relationship between CAVI and atherosclerotic progression is strongly confounded by age. Thus, age should be taken into account when CAVI is used as an indicator of atherosclerotic progression.