Roles of arterial pressure volume index and arterial velocity pulse index trajectories in risk prediction in hypertensive patients with heart failure with preserved ejection fraction

ABSTRACT

Background: Arterial pressure volume index (API) and arterial velocity pulse index (AVI) contribute to the development of vascular damage and cardiovascular disease. However, the relationship between common API/AVI trajectories and cardiovascular outcomes in hypertensive patients with heart failure with preserved ejection fraction (HFpEF) is unknown.

Methods: A total of 488 consecutive hypertensive patients with HFpEF who repeatedly underwent API/AVI measurements were prospectively examined. We then applied API/AVI measurements into actual clinical practice. Latent mixture modeling was performed to identify API/AVI trajectories. Hazards ratios (HRs) were measured using Cox proportional hazard models.

Results: We identified four distinct API/AVI trajectory patterns: low (7.6%), moderate (43.8%), high (28.9%), and very high (19.7%). Compared with the low group, higher API trajectories were associated with increased risk of total cardiovascular events (high group, adjusted HR: 2.91, 95% confidence interval [CI]: 1.97–4.26; very high group, adjusted HR: 2.46, 95%CI: 1.18–3.79). Consistently, higher AVI trajectories were also associated with a higher risk of total cardiovascular events (high group, adjusted HR: 2.58, 95%CI: 1.23–5.47; very high group, adjusted HR: 3.12, 95%CI: 1.83–6.08), compared with the low trajectory group.

Conclusion: High API/AVI trajectories are strong predictors of cardiovascular risk in hypertensive patients with HFpEF. Among these patients, measuring API/AVI may improve risk stratification and provide additional information to tailor treatment strategies.

KEYWORDS:

• Arterial pressure volume index
• arterial velocity pulse index
• trajectory
• heart failure with preserved ejection fraction
• prognosis

Acknowledgments

The authors thank all the colleagues who cooperated with them.

Contributions

Peijian Wang and Jindong Wan conceived and designed the experiments; all authors performed the experiments; Sen Liu, Yi Yang, Dan Wang, and Fei Ran analyzed the data; Peng Zhou, Siwei Xia and Jixin Hou contributed reagents/materials/analysis tools; Yi Yang, Peijian Wang, Yun Sun and Shuangtao Ma drafted and revised the paper. All authors read and approved the final manuscript.

Disclosure

The authors declare that they have no competing interests.

Additional information

Funding

This research was supported by grants from the National Natural Science Foundation of China (81400289, 81970262, 81641058) (PJW, PZ) and the Program of Sichuan Youth Science and Technology Foundation in China (2016JQ0032) (PJW), Innovation Team Project Department of Education of Sichuan Province (18TD0030) (PJW).