The relationship between arterial stiffness and heart failure with preserved ejection fraction: a systemic meta-analysis
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Updated: Apr 16, 2026
Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
1Department of Medicine (Cardiology), University of British Columbia, Level 9 - 2775 Laurel St, Vancouver, B.C., V5Z 1M9, Canada.
Insights
Arterial stiffness, measured by arterial tonometry, is linked to diastolic dysfunction. Brachial-ankle pulse wave velocity (baPWV) showed the strongest association, suggesting its role in heart failure with preserved ejection fraction (HFpEF).
Area of Science:
- Cardiovascular Medicine
- Clinical Physiology
- Biomedical Engineering
Background:
- Heart failure with preserved ejection fraction (HFpEF) diagnosis relies on identifying diastolic dysfunction.
- Arterial stiffness is increasingly recognized as a contributor to cardiovascular disease.
- The relationship between various arterial tonometry measures and diastolic dysfunction requires comprehensive evaluation.
Purpose of the Study:
- To investigate the correlation between arterial stiffness, assessed via arterial tonometry, and echocardiographic indices of diastolic dysfunction.
- To determine which arterial tonometry technique demonstrates the strongest association with diastolic dysfunction.
- To explore the potential role of arterial stiffness as a causative factor in HFpEF.
Main Methods:
- Systematic literature search of OvidSP Medline, Embase, and PubMed.
- Inclusion of 27 studies (6,626 patients) correlating arterial stiffness (baPWV, cfPWV, AIx, CAVI) with diastolic indices (E/A ratio, e', E/e').
- Meta-analysis of correlation coefficients using a random-effects model.
Main Results:
- Significant correlations were found between brachial-ankle pulse wave velocity (baPWV) and E/A ratio (r = -0.434), e' (r = -0.499), and E/e' ratio (r = 0.372).
- Other arterial stiffness measures (cfPWV, AIx, CAVI) also showed significant correlations with diastolic indices, but with varying strengths and consistency.
- baPWV exhibited the most consistent and strongest association with diastolic dysfunction compared to other tonometric techniques.
Conclusions:
- Arterial stiffness, particularly when measured by baPWV, is a significant indicator of diastolic dysfunction.
- These findings support the consideration of arterial stiffness as a key factor in the pathophysiology of HFpEF.
- A potential refocus on the impact of arterial stiffness on left ventricular function may offer new insights into HFpEF development and management.
Abstract:
The objective is to investigate the relationship between arterial stiffness measured by arterial tonometry and echocardiographic indices of diastolic dysfunction-a basis for the diagnosis of heart failure with preserved ejection fraction (HFpEF). OvidSP Medline, Embase and PubMed were systematically searched. Eligible articles correlated arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV), carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx) or cardio-ankle vascular index (CAVI) with indices of diastolic dysfunction, E/A ratio, peak early mitral annular velocity (e') and E/e' ratio. Correlation coefficients were determined using a random-effects model. Twenty-seven studies with 6,626 patients were included. baPWV was significantly correlated with E/A ratio (r = -0.434, 95 % CI -0.387 to -0.479), e' (r = -0.499, 95 % CI -0.448 to -0.548) and E/e' ratio (r = 0.372, 95 % CI 0.251-0.481). cfPWV was significantly correlated with E/A ratio (r = -0.391, 95 % CI -0.304 to -0.470) and E/e' ratio (r = 0.210, 95 % CI 0.300-0.116), but not e'. AIx was significantly correlated with E/A ratio (r = -0.356, 95 % CI -0.255 to -0.450), e' (r = -0.313, 95 % CI -0.195 to -0.423) and E/e' ratio (r = 0.321, 95 % CI 0.250-0.388). CAVI was significantly correlated with E/A ratio (r = -0.405, CI -0.324 to -0.481), e' (r = -0.449, 95 % CI -0.340 to -0.630), but not E/e'. baPWV showed significantly greater correlation with diastolic dysfunction compared to most other tonometric techniques. Arterial stiffness measured by arterial tonometry is an indicator of diastolic dysfunction with baPWV demonstrated the most consistent and strongest association. These data suggest a refocusing on the impact of arterial stiffness on the left ventricle as a potential causative factor leading to HFpEF.
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