The Prognostic Role of Aortic Stiffness in Patients Hospitalized for an Acute Heart Failure Syndrome

Authors

Sophia Giannitsi^1, , Mara Bougiakli¹, Aris Bechlioulis^1, , Anna Kotsia¹, Lampros Lakkas¹, Ioannis Girdis^1, , Konstantinos Pappas¹, Georgios Chasiotis^2, , Eleni Bairaktari^2, , Andreas Kalogeropoulos^3, , Lampros K. Michalis^1, , Katerina K. Naka^{1, *,}

¹2nd Department of Cardiology and Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece

²Laboratory of Clinical Chemistry, University Hospital of Ioannina, Ioannina, Greece

³Department of Cardiology, University of Patras, Patras, Greece

^*Corresponding author. Email: drkknaka@gmail.com; anaka@uoi.gr

DOI

10.2991/artres.k.200930.001How to use a DOI?

Keywords

Acute heart failure; prognosis; aortic stiffness; pulse wave velocity; pulsatile hemodynamics

Abstract

Background: Although impaired arterial function has been associated with adverse prognosis in chronic Heart Failure (HF), its role in Acute HF Syndromes (AHFS) has been little studied. We prospectively investigated the prognostic role of arterial function on mortality and HF Hospitalizations (HHF) in patients with AHFS.

Design and Methods: A thorough assessment of arterial function was performed in patients hospitalized for AHFS 24–48 h before discharge and followed-up for 6 months for all-cause death and HHF. MAGGIC risk score was used to evaluate the additive predictive value of vascular biomarkers for clinical events.

Results: One-hundred patients were studied; aged 70 ± 11 years, 78% males, 61% had left ventricular ejection fraction ≤40% and 24% ≥50%. Mean aortic Pulse Wave Velocity (PWV) was 11.2 m/s, mean augmentation index 21% and median brachial flow-mediated dilation 3.14%. Higher PWV was associated with all-cause mortality (Hazard Ratio [HR] 1.32 per 1 m/s, p < 0.001) and the combined clinical event of mortality and HHF (HR 1.12 per 1 m/s, p = 0.012) even after adjustment for MAGGIC score. MAGGIC score predicted mortality (HR 3.40 per group increase, Area under Curve [AUC] = 0.741, p = 0.017) in our population; addition of PWV to MAGGIC score increased the predictive accuracy (AUC = 0.911, C-statistic p < 0.01 vs. MAGGIC score alone) for mortality.

Conclusion: In these AHFS patients, increased aortic stiffness was independently associated with mortality and further improved the predictive accuracy of an established risk model. Further research is needed to show whether a comprehensive assessment of AHFS patients focusing both on cardiac and vascular function, may improve management and ameliorate prognosis following an AHF hospitalization.

HIGHLIGHTS

• •

  The interaction between the heart and the arteries is a determinant of cardiovascular function.

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  Increased aortic Pulse Wave Velocity (PWV) predicts mortality in acute heart failure.

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  Aortic PWV increases predictive accuracy of MAGGIC score.

Copyright

© 2020 Association for Research into Arterial Structure and Physiology. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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TY  - JOUR
AU  - Sophia Giannitsi
AU  - Mara Bougiakli
AU  - Aris Bechlioulis
AU  - Anna Kotsia
AU  - Lampros Lakkas
AU  - Ioannis Girdis
AU  - Konstantinos Pappas
AU  - Georgios Chasiotis
AU  - Eleni Bairaktari
AU  - Andreas Kalogeropoulos
AU  - Lampros K. Michalis
AU  - Katerina K. Naka
PY  - 2020
DA  - 2020/10/06
TI  - The Prognostic Role of Aortic Stiffness in Patients Hospitalized for an Acute Heart Failure Syndrome
JO  - Artery Research
SP  - 7
EP  - 13
VL  - 27
IS  - 1
SN  - 1876-4401
UR  - https://doi.org/10.2991/artres.k.200930.001
DO  - 10.2991/artres.k.200930.001
ID  - Giannitsi2020
ER  -