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Arterial stiffness and left ventricular diastolic dysfunction: insights from the cardio-ankle vascular index

Tuan Hoang Nguyen1, Takamitsu Nakamura1, Takeo Horikoshi1

  • 1Department of Cardiovascular Medicine, University of Yamanashi, Faculty of Medicine, 1110 Shimokato, Chuo 409-3898 Japan.

Heart & Lung : the Journal of Critical Care
|February 12, 2026
PubMed

Insights

Arterial stiffness, measured by Cardio-Ankle Vascular Index (CAVI), independently elevates left ventricular filling pressure. This stiffness also mediates age-related effects on diastolic dysfunction, impacting heart failure risk.

Area of Science:

  • Cardiovascular Medicine
  • Vascular Physiology
  • Diabetology

Background:

  • Arterial stiffness contributes to cardiovascular morbidity.
  • Its precise role in elevated left ventricular (LV) filling pressure and heart failure with preserved ejection fraction (HFpEF) requires further elucidation.

Purpose of the Study:

  • To investigate the relationship between arterial stiffness (CAVI) and elevated LV filling pressure (E/e' ratio).
  • To assess the association between arterial stiffness and LV diastolic dysfunction.
  • To explore the mediating role of CAVI in age-related effects on LV filling pressure.

Main Methods:

  • Cross-sectional analysis of 335 patients with cardiovascular disease and preserved ejection fraction (≥50%).
  • Cardio-Ankle Vascular Index (CAVI) measurement.
  • Multivariable logistic regression and smoothing spline analysis to assess associations and dose-response relationships.
  • Mediation analysis to determine direct and indirect effects of CAVI, age, and hypertension on elevated filling pressure (E/e' >14).

Main Results:

  • CAVI was independently associated with elevated LV filling pressure (E/e' >14) and diastolic dysfunction.
  • CAVI improved risk stratification for elevated filling pressure.
  • A near-exponential increase in risk was observed above a CAVI threshold of 9.275.
  • CAVI accounted for 18.7% of the effect of age on elevated E/e'.

Conclusions:

  • Arterial stiffness, quantified by CAVI, is an independent predictor of elevated LV filling pressure.
  • CAVI plays a significant role in mediating age-related increases in LV filling pressure.
  • These findings highlight the importance of assessing arterial stiffness in patients with HFpEF.
Abstract

Keywords:
Arterial stiffnessCardio ankle vascular indexHeart failureLeft ventricular dysfunctionMediation analysisSex characteristics

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