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Association Between Cardio-Ankle Vascular Index and Heart Failure Outcomes: Insights From a Prospective Multicenter
Toru Miyoshi1, Kohji Shirai2, Shigeo Horinaka3
1Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
Insights
Elevated cardio-ankle vascular index (CAVI) independently predicts heart failure hospitalizations and cardiovascular death. This arterial stiffness marker modestly improves risk prediction beyond conventional factors in at-risk adults.
Area of Science:
- Cardiovascular Medicine
- Preventive Cardiology
- Biomarker Research
Background:
- Heart failure (HF) poses a significant public health challenge with poor prognosis.
- Arterial stiffness, a contributor to HF, is assessed by the cardio-ankle vascular index (CAVI).
- The prognostic value of CAVI in HF patients requires further clarification.
Purpose of the Study:
- To determine if CAVI independently predicts HF-related hospitalizations.
- To assess if CAVI adds prognostic value beyond established cardiovascular risk factors.
Main Methods:
- A sub-analysis of the prospective CAVI-J study included 2,932 Japanese adults (40-74 years) with cardiovascular risk factors.
- Participants were stratified by CAVI tertiles and followed for a median of 4.9 years.
- Cox proportional hazards models and reclassification indices evaluated risk and incremental prognostic value for HF hospitalization and cardiovascular death.
Main Results:
- High CAVI (≥9.0) was independently associated with a 3.18-fold increased risk of primary outcomes (P=0.034).
- Adding CAVI to conventional risk models significantly improved risk prediction (global chi-squared increase from 8.82 to 18.77, P=0.002).
- The net reclassification index was 0.621 (P<0.001), indicating improved prediction accuracy.
Conclusions:
- Elevated CAVI is an independent predictor of HF hospitalizations and cardiovascular death.
- CAVI modestly enhances risk prediction beyond conventional factors in individuals with cardiovascular risk factors.
- Further research is needed to fully establish the clinical utility of CAVI in HF risk stratification.
Background:
Heart failure (HF) is a substantial public health concern associated with poor prognosis and limited tools for early prediction. Arterial stiffness contributes to the development of HF, particularly with a preserved ejection fraction. The cardio-ankle vascular index (CAVI) is a noninvasive, pressure-independent marker of arterial stiffness. However, its prognostic value in HF remains unclear.
Objectives:
We aimed to evaluate whether CAVI independently predicts HF-related hospitalizations in patients with cardiovascular risk factors and whether it adds prognostic value beyond conventional risk factors.
Methods:
This subanalysis of the multicenter prospective CAVI-J (Prospective Multicenter Study to Evaluate Usefulness of CAVI in Japan) study included 2,932 Japanese adults aged 40 to 74 years with cardiovascular risk factors. Participants were stratified into CAVI tertiles and followed up for a median of 4.9 years. The primary outcomes were HF-related hospitalizations and cardiovascular death. Cox proportional hazards models were used to assess the risk, and the incremental prognostic value was evaluated using global chi-square statistics and reclassification indices.
Results:
Primary outcomes were recorded in 32 patients (1.1%). High CAVI (≥9.0) was independently associated with an increased risk (HR: 3.18; 95% CI: 1.09-9.31; P = 0.034). When CAVI was added to a model with known conventional risks, the global chi value increased from 8.82 to 18.77 (P = 0.002), and the net reclassification index was 0.621 (P < 0.001).
Conclusions:
In this exploratory study, elevated CAVI was associated with HF-related hospitalizations and cardiovascular death and modestly improved the risk prediction beyond conventional risk factors. However, the discriminative ability remained limited, and further studies are warranted to establish its clinical utility.
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