Cardio-ankle vascular index predicts the 1-year prognosis of heart failure patients categorized in clinical scenario 1
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ORIGINAL ARTICLE
Cardio‑ankle vascular index predicts the 1‑year prognosis of heart failure patients categorized in clinical scenario 1 Takahide Sano1 · Shunsuke Kiuchi1 · Shinji Hisatake1 · Takayuki Kabuki1 · Takashi Oka1 · Takahiro Fujii1 · Shintaro Dobashi1 · Takanori Ikeda1 Received: 4 March 2020 / Accepted: 22 May 2020 © Springer Japan KK, part of Springer Nature 2020
Abstract The sudden increase in blood pressure by vascular dysfunction is associated with the development of acute decompensated heart failure (ADHF) categorized in clinical scenario (CS) 1. However, the relationship between vascular function and prognosis in ADHF patients with CS1 is unclear. 3239 consecutive ADHF patients between January 2012 and June 2018 were enrolled. ADHF patients with CS1 undergoing ankle brachial index/cardio-ankle vascular index (CAVI) were included and patients with peripheral artery disease were excluded. Finally, 113 patients were analyzed. The primary endpoint of the present study was composite endpoint at 1 year (the cardiac death or re-hospitalization by ADHF). Cox proportional hazard analysis was conducted to identify independent predictors of composite endpoint. 25 patients (22.1%) were developed composite endpoint. CAVI in patients who have composite endpoint were significantly higher than without non-composite endpoint (composite endpoint group: 9.9 ± 1.3 non-composite endpoint group 8.7 ± 1.7, P = 0.001). The composite endpoint group was elderly and had higher ejection fraction, lower hemoglobin, and less used beta blockers, and renin angiotensin aldosterone system inhibitors. After adjustment by these confounding factors, CAVI was independently associated with the occurrence of composite endpoint (hazard ratio 1.69, 95% CI 1.05–2.73, P = 0.032). A cut-off value of CAVI for predicting composite endpoint was 8.65 (sensitivity 0.444, specificity 0.920, area under the curve 0.724, 95% CI 0.614–0.834). High CAVI was associated with the occurrence of composite endpoint after CS1 ADHF. Keywords Cardio-ankle vascular index · Heart failure · Vascular failure · Clinical scenario
Introduction In Japan, heart failure (HF) patients will be expected to increase to about 1.3 million in 2030 [1], and which is socalled HF pandemic, like infective epidemic diseases. This problem is same in other countries, and the increasing number of HF patients is a worldwide problem. In Japan, which is facing problem of "super-aging", it is necessary to take particular care of the increase in elderly HF patients, and there are many HF preserved Ejection Fraction (HFpEF) patients with maintained EF among elderly HF patients [2]. On the other hand, the pathophysiology of HF is divided into cardiac failure and vascular failure [3]. Although EF is * Shunsuke Kiuchi [email protected]‑u.ac.jp 1
Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, 6‑11‑1 Omori‑nishi, Ota‑ku, Tokyo 143‑8541, Japan
maintained in both cardiac diastolic dysfunction and HFpEF, the presence or absence of HF is not problem in the
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