The prognostic role of aortic stiffness in patients hospitalized for an acute heart failure syndrome

Background: Although impaired arterial function has been associated with adverse prognosis in chronic Heart Failure (HF), its role in Acute HF Syndromes (AHFS) has been little studied. We prospectively investigated the prognostic role of arterial function on mortality and HF Hospitalizations (HHF) in patients with AHFS. Design and Methods: A thorough assessment of arterial function was performed in patients hospitalized for AHFS 24-48 h before discharge and followed-up for 6 months for all-cause death and HHF. MAGGIC risk score was used to evaluate the additive predictive value of vascular biomarkers for clinical events. Results: One-hundred patients were studied; aged 70 ± 11 years, 78% males, 61% had left ventricular ejection fraction ≤40% and 24% ≥50%. Mean aortic Pulse Wave Velocity (PWV) was 11.2 m/s, mean augmentation index 21% and median brachial flow-mediated dilation 3.14%. Higher PWV was associated with all-cause mortality (Hazard Ratio [HR] 1.32 per 1 m/s, p < 0.001) and the combined clinical event of mortality and HHF (HR 1.12 per 1 m/s, p = 0.012) even after adjustment for MAGGIC score. MAGGIC score predicted mortality (HR 3.40 per group increase, Area under Curve [AUC] = 0.741, p = 0.017) in our population; addition of PWV to MAGGIC score increased the predictive accuracy (AUC = 0.911, C-statistic p < 0.01 vs. MAGGIC score alone) for mortality. Conclusion: In these AHFS patients, increased aortic stiffness was independently associated with mortality and further improved the predictive accuracy of an established risk model. Further research is needed to show whether a comprehensive assessment of AHFS patients focusing both on cardiac and vascular function, may improve management and ameliorate prognosis following an AHF hospitalization.