Skip to main content
Download PDF
  • Research Article
  • Open access
  • Published:

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

Artery Research volume 27, pages 7–13 (2021)Cite this article

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.

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

  • Aortic PWV increases predictive accuracy of MAGGIC score.

References

  1. Savarese G, Lund LH. Global public health burden of heart failure. Card Fail Rev 2017;3:7–11.

    Google Scholar 

  2. Cheema B, Ambrosy AP, Kaplan RM, Senni M, Fonarow GC, Chioncel O, et al. Lessons learned in acute heart failure. Eur J Heart Fail 2018;20:630–41.

    Google Scholar 

  3. Sliwa K, Davison BA, Mayosi BM, Damasceno A, Sani M, Ogah OS, et al. Readmission and death after an acute heart failure event: predictors and outcomes in sub-saharan africa: Results from the THESUS-HF registry. Eur Heart J 2013;34:3151–9.

    Google Scholar 

  4. Thavendiranathan P, Yingchoncharoen T, Grant A, Seicean S, Landers SH, Gorodeski EZ, et al. Prediction of 30-day heart failure- specific readmission risk by echocardiographic parameters. Am J Cardiol 2014;113:335–41.

    Google Scholar 

  5. Passantino A, Monitillo F, Iacoviello M, Scrutinio D. Predicting mortality in patients with acute heart failure: role of risk scores. World J Cardiol 2015;7:902–11.

    Google Scholar 

  6. Mitchell GF, Hwang SJ, Vasan RS, Larson MG, Pencina MJ, Hamburg NM, et al. Arterial stiffness and cardiovascular events: the framingham heart study. Circulation 2010;121:505–11.

    Google Scholar 

  7. Duprez DA, Jacobs Jr DR, Lutsey PL, Bluemke DA, Brumback LC, Polak JF, et al. Association of small artery elasticity with incident cardiovascular disease in older adults: the multi-ethnic study of atherosclerosis. Am J Epidemiol 2011;174:528–36.

    Google Scholar 

  8. Tsao CW, Lyass A, Larson MG, Levy D, Hamburg NM, Vita JA, et al. Relation of central arterial stiffness to incident heart failure in the community. J Am Heart Assoc 2015;4:e002189.

  9. Aisu H, Saito M, Inaba S, Morofuji T, Takahashi K, Sumimoto T, et al. Association of worsening arterial stiffness with incident heart failure in asymptomatic patients with cardiovascular risk factors. Hypertens Res 2017;40:173–80.

    Google Scholar 

  10. Desai AS, Mitchell GF, Fang JC, Creager MA. Central aortic stiffness is increased in patients with heart failure and preserved ejection fraction. J Card Fail 2009;15:658–64.

    Google Scholar 

  11. Marti CN, Gheorghiade M, Kalogeropoulos AP, Georgiopoulou VV, Quyyumi AA, Butler J. Endothelial dysfunction, arterial stiffness, and heart failure. J Am Coll Cardiol 2012;60:1455–69.

    Google Scholar 

  12. Ikonomidis I, Aboyans V, Blacher J, Brodmann M, Brutsaert DL, Chirinos JA, et al. The role of ventricular-arterial coupling in cardiac disease and heart failure: Assessment, clinical implications and therapeutic interventions. A consensus document of the european society of cardiology working group on aorta & peripheral vascular diseases, european association of cardiovascular imaging, and heart failure association. Eur J Heart Fail 2019;21:402–24.

    Google Scholar 

  13. Meguro T, Nagatomo Y, Nagae A, Seki C, Kondou N, Shibata M, et al. Elevated arterial stiffness evaluated by brachial-ankle pulse wave velocity is deleterious for the prognosis of patients with heart failure. Circ J 2009;73:673–80.

    Google Scholar 

  14. Shechter M, Matetzky S, Arad M, Feinberg MS, Freimark D. Vascular endothelial function predicts mortality risk in patients with advanced ischaemic chronic heart failure. Eur J Heart Fail 2009;11:588–93.

    Google Scholar 

  15. Bonapace S, Rossi A, Cicoira M, Targher G, Valbusa F, Benetos A, et al. Increased aortic pulse wave velocity as measured by echocardiography is strongly associated with poor prognosis in patients with heart failure. J Am Soc Echocardiogr 2013;26:714–20.

    Google Scholar 

  16. Demir Ş, Akpınar O, Akkus O, Nas K, Unal I, Molnar F, et al. The prognostic value of arterial stiffness in systolic heart failure. Cardiol J 2013;20:665–71.

    Google Scholar 

  17. Aronson D, Burger AJ. Relation between pulse pressure and survival in patients with decompensated heart failure. Am J Cardiol 2004;93:785–8.

    Google Scholar 

  18. Sung SH, Yu WC, Cheng HM, Lee CW, Lin MM, Chuang SY, et al. Excessive wave reflections on admission predict post-discharge events in patients hospitalized due to acute heart failure. Eur J Heart Fail 2012;14:1348–55.

    Google Scholar 

  19. Sung SH, Yu WC, Cheng HM, Chuang SY, Wang KL, Huang CM, et al. Pulsatile hemodynamics and clinical outcomes in acute heart failure. Am J Hypertens 2011;24:775–82.

    Google Scholar 

  20. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, et al. 2016 ESC guidelines for the diagnosis and treatment of acute and chronic heart failure: The task force for the diagnosis and treatment of acute and chronic heart failure of the european society of cardiology (ESC) developed with the special contribution of the heart failure association (HFA) of the ESC. Eur Heart J 2016;37:2129–200.

    Google Scholar 

  21. Pocock SJ, Ariti CA, McMurray JJ, Maggioni A, Kober L, Squire IB, et al. Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. Eur Heart J 2013;34:1404–13.

    Google Scholar 

  22. Khanam SS, Choi E, Son JW, Lee JW, Youn YJ, Yoon J, et al. Validation of the MAGGIC (meta-analysis global group in chronic heart failure) heart failure risk score and the effect of adding natriuretic peptide for predicting mortality after discharge in hospitalized patients with heart failure. PLoS One 2018;13:e0206380.

  23. Vlahos AP, Theocharis P, Bechlioulis A, Naka KK, Vakalis K, Papamichael ND, et al. Changes in vascular function and structure in juvenile idiopathic arthritis. Arthritis Care Res (Hoboken) 2011;63:1736–44.

    Google Scholar 

  24. Bechlioulis A, Vakalis K, Naka KK, Bourantas CV, Papamichael ND, Kotsia A, et al. Increased aortic pulse wave velocity is associated with the presence of angiographic coronary artery disease in overweight and obese patients. Am J Hypertens 2013;26:265–70.

    Google Scholar 

  25. Thijssen DHJ, Bruno RM, van Mil ACCM, Holder SM, Faita F, Greyling A, et al. Expert consensus and evidence-based recommendations for the assessment of flow-mediated dilation in humans. Eur Heart J 2019;40:2534–47.

    Google Scholar 

  26. Van Bortel LM, Laurent S, Boutouyrie P, Chowienczyk P, Cruickshank JK, De Backer T, et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. J Hypertens 2012;30:445–8.

    Google Scholar 

  27. Zimlichman R, Shargorodsky M, Boaz M, Duprez D, Rahn KH, Rizzoni D, et al. Determination of arterial compliance using blood pressure waveform analysis with the CR-2000 system: reliability, repeatability, and establishment of normal values for healthy european population—the seven European sites study (SESS). Am J Hypertens 2005;18:65–71.

    Google Scholar 

  28. Hanley JA, McNeil BJ. The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 1982;143:29–36.

    Google Scholar 

  29. Chirinos JA, Segers P, Hughes T, Townsend R. Large-artery stiffness in health and disease: JACC state-of-the-art review. J Am Coll Cardiol 2019;74:1237–63.

    Google Scholar 

  30. Ooi H, Chung W, Biolo A. Arterial stiffness and vascular load in heart failure. Congest Heart Fail 2008;14:31–6.

    Google Scholar 

  31. Kim DB, Baek SH, Jang SW, Her SH, Shin DI, Park CS, et al. Improvement of arterial stiffness in the transition from acute decompensated heart failure to chronic compensated heart failure. Clin Cardiol 2013;36:358–62.

    Google Scholar 

  32. Grosman-Rimon L, Billia F, Wright E, Carasso S, Elbaz-Greener G, Kachel E, et al. Neurohormones, inflammatory mediators, and cardiovascular injury in the setting of heart failure. Heart Fail Rev 2020;25:685–701.

    Google Scholar 

  33. Gheorghiade M, Abraham WT, Albert NM, Greenberg BH, O’Connor CM, She L, et al. Systolic blood pressure at admission, clinical characteristics, and outcomes in patients hospitalized with acute heart failure. JAMA 2006;296:2217–26.

    Google Scholar 

  34. Milo-Cotter O, Adams KF, O’Connor CM, Uriel N, Kaluski E, Felker GM, et al. Acute heart failure associated with high admission blood pressure—a distinct vascular disorder? Eur J Heart Fail 2007;9:178–83.

  35. Gheorghiade M, Pang PS. Acute heart failure syndromes. J Am Coll Cardiol 2009;53:557–73.

    Google Scholar 

  36. Regnault V, Lagrange J, Pizard A, Safar ME, Fay R, Pitt B, et al. Opposite predictive value of pulse pressure and aortic pulse wave velocity on heart failure with reduced left ventricular ejection fraction: insights from an eplerenone post-acute myocardial infarction heart failure efficacy and survival study (EPHESUS) substudy. Hypertension 2014;63:105–11.

    Google Scholar 

  37. Weber T, Chirinos JA. Pulsatile arterial haemodynamics in heart failure. Eur Heart J 2018;39:3847–54.

    Google Scholar 

  38. Naka KK, Ikonomidis I. Brachial pulse pressure in heart failure: simple to measure but complex to interpret. Eur Heart J 2019;40:e8–e10.

    Google Scholar 

  39. Takishima I, Nakamura T, Hirano M, Kitta Y, Kobayashi T, Fujioka D, et al. Predictive value of serial assessment of endothelial function in chronic heart failure. Int J Cardiol 2012;158:417–22.

    Google Scholar 

  40. Colombo PC, Onat D, Sabbah HN. Acute heart failure as “acute endothelitis”—interaction of fluid overload and endothelial dysfunction. Eur J Heart Fail 2008;10:170–5.

    Google Scholar 

  41. Katz SD, Hryniewicz K, Hriljac I, Balidemaj K, Dimayuga C, Hudaihed A, et al. Vascular endothelial dysfunction and mortality risk in patients with chronic heart failure. Circulation 2005;111:310–14.

    Google Scholar 

  42. Meyer B, Mortl D, Strecker K, Hulsmann M, Kulemann V, Neunteufl T, et al. Flow-mediated vasodilation predicts outcome in patients with chronic heart failure: comparison with B-type natriuretic peptide. J Am Coll Cardiol 2005;46:1011–18.

    Google Scholar 

  43. Santaguida PL, Don-Wauchope AC, Oremus M, McKelvie R, Ali U, Hill SA, et al. BNP and NT-proBNP as prognostic markers in persons with acute decompensated heart failure: a systematic review. Heart Fail Rev 2014;19:453–70.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. 2nd Department of Cardiology and Michaelidion Cardiac Center, University of Ioannina, Ioannina, Greece

    Sophia Giannitsi, Mara Bougiakli, Aris Bechlioulis, Anna Kotsia, Lampros Lakkas, Ioannis Girdis, Konstantinos Pappas, Lampros K. Michalis & Katerina K. Naka

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

    Georgios Chasiotis & Eleni Bairaktari

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

    Andreas Kalogeropoulos

Authors
  1. Sophia Giannitsi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mara Bougiakli
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Aris Bechlioulis
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anna Kotsia
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lampros Lakkas
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ioannis Girdis
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Konstantinos Pappas
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Georgios Chasiotis
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Eleni Bairaktari
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Andreas Kalogeropoulos
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Lampros K. Michalis
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Katerina K. Naka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Katerina K. Naka.

Additional information

Peer review under responsibility of the Association for Research into Arterial Structure and Physiology

Data availability statement: The data that support the findings of this study are available from the corresponding author, Dr Katerina K. Naka, upon reasonable request.

Rights and permissions

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

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Giannitsi, S., Bougiakli, M., Bechlioulis, A. et al. The Prognostic Role of Aortic Stiffness in Patients Hospitalized for an Acute Heart Failure Syndrome. Artery Res 27, 7–13 (2021). https://doi.org/10.2991/artres.k.200930.001

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2991/artres.k.200930.001

Keywords

Artery Research

ISSN: 1876-4401

Contact us