Increased Cardio-Ankle Vascular Index Is Associated With the Development of Heart Failure in Patients With Preserved Ejection Fraction

Background: Increased arterial stiffness has been reported to be associated with heart failure. The aim of this study was to evaluate the association of cardio-ankle vascular index (CAVI) as a marker of arterial stiffness with the development of heart failure in patients with persevered ejection fraction. Methods: This retrospective observational study included consecutive 327 patients with ejection fraction over 50% and cardiovascular risk factors, but without known coronary artery disease (68 ± 9 years, 59% men). The primary outcome was hospitalization of heart failure. Results: During follow-up (median, 26 months), the primary outcome was documented in 1.2%. CAVI in patient with heart failure was significantly higher than that without heart failure (10.3 ± 0.93 vs 8.91 ± 1.31, P = .025). The ROC curve analysis of CAVI for discriminating development of heart failure showed that the sensitivity 75% and specificity 87% at the cut off value of 10.4 (AUC = 0.827, P = .024). When patients were divided into two groups based on CAVI of 10.4, the Kaplan-Meier estimate showed that events occurred more frequently in higher CAVI group (0.4% and 6.5%, log-rank test, P < .001). Multiple Cox analysis showed that CAVI was an independent predictor of heart failure (HR 2.90 per 1 index, 95%CI 1.16–7.22, P = .02). Conclusion: Increased CAVI is associated with the development of heart failure with preserved ejection fraction.