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Association Between Longitudinal Changes in Cardio-Ankle Vascular Index and Aortic Stenosis Progression in Dialysis

Shunsuke Todani1,2, Kazuhiro Shimizu2, Shuji Sato2

  • 1Division of Diabetes, Metabolism, and Endocrinology, Department of Internal Medicine, Toho University Graduate School of Medicine, Tokyo, JPN.

Cureus
|September 29, 2025
PubMed

Insights

In dialysis patients, a declining cardio-ankle vascular index (CAVI) signals worsening aortic stenosis (AS). Serial CAVI monitoring can help predict severe AS and guide valve replacement timing when echocardiography is unclear.

Area of Science:

  • Cardiovascular Medicine
  • Nephrology
  • Vascular Biology

Background:

  • Echocardiography often underestimates aortic stenosis (AS) progression in dialysis patients due to blood pressure variability and calcification.
  • The cardio-ankle vascular index (CAVI), a blood pressure-independent measure of arterial stiffness, may offer a more reliable assessment.
  • Predicting severe AS progression and optimizing valve replacement timing are critical in this high-risk population.

Purpose of the Study:

  • To evaluate if serial changes in CAVI can anticipate severe AS progression in maintenance dialysis patients.
  • To determine if CAVI can guide the timing of aortic valve replacement (AVR/TAVR) when echocardiographic findings are ambiguous.

Main Methods:

  • Retrospective analysis of 1,169 maintenance dialysis patients, focusing on 41 who underwent AVR/TAVR.
  • CAVI measurements were taken at four time points: 2 years, 1 year, and immediately before AVR/TAVR, and 1 year after.
  • Severe AS progression defined as mean pressure gradient (meanPG) ≥ 40 mmHg; multivariable logistic regression identified progression determinants.

Main Results:

  • Median CAVI declined significantly in the two years preceding AVR/TAVR (p < 0.001) and normalized post-procedure (p < 0.001).
  • A greater CAVI decline (ΔCAVI) was associated with progression to severe AS (p = 0.022).
  • ΔCAVI was the sole independent predictor of severe AS progression (OR 0.51 per 1-unit decrease; p = 0.013).

Conclusions:

  • A significant preoperative decline in CAVI nearly doubles the risk of emergent severe AS in dialysis patients.
  • Serial CAVI monitoring is a simple, noninvasive tool that may provide an early warning for severe AS.
  • CAVI monitoring could help optimize intervention timing in dialysis patients with ambiguous echocardiographic results.

Keywords:
aortic stenosisaortic valve replacementarterial stiffnesscardio-ankle vascular indexhemodialysis

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