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Rising arterial stiffness with accumulating comorbidities associates with heart failure with preserved ejection fraction
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Ali, Danish, Tran, Patrick, Ennis, Stuart, Powell, Richard, McGuire, Scott, McGregor, Gordon, Kimani, Peter K., Weickert, Martin O., Miller, Michelle A., Cappuccio, Francesco P. and Banerjee, Prithwish (2023) Rising arterial stiffness with accumulating comorbidities associates with heart failure with preserved ejection fraction. ESC Heart Failure, 10 (4). pp. 2487-2498. doi:10.1002/ehf2.14422 ISSN 2055-5822.
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WRAP-rising-arterial-stiffness-accumulating-comorbidities-associates-heart-failure-preserved-ejection-fraction-2023.pdf - Published Version - Requires a PDF viewer. Available under License Creative Commons Attribution Non-commercial No Derivatives 4.0. Download (331Kb) | Preview |
Official URL: https://doi.org/10.1002/ehf2.14422
Abstract
Aims: Comorbidities play a significant role towards the pathophysiology of heart failure with preserved ejection fraction (HFpEF), characterized by abnormal macrovascular function and altered ventricular–vascular coupling. However, our understanding of the role of comorbidities and arterial stiffness in HFpEF remains incomplete. We hypothesized that HFpEF is preceded by a cumulative rise in arterial stiffness as cardiovascular comorbidities accumulate, beyond that associated with ageing. Methods and results: Arterial stiffness was assessed using pulse wave velocity (PWV) in five groups: Group A, healthy volunteers (n = 21); Group B, patients with hypertension (n = 21); Group C, hypertension and diabetes mellitus (n = 20); Group D, HFpEF (n = 21); and Group E, HF with reduced ejection fraction (HFrEF) (n = 11). All patients were aged 70 and above. Mean PWV increased from Groups A to D (PWV 10.2, 12.2, 13.0, and 13.7 m/s, respectively) as vascular comorbidities accumulated independent of age, renal function, haemoglobin, obesity (body mass index), smoking status, and hypercholesterolaemia. HFpEF exhibited the highest PWV and HFrEF displayed near‐normal levels (13.7 vs. 10 m/s, P = 0.003). PWV was inversely related to peak oxygen consumption (r = −0.304, P = 0.03) and positively correlated with left ventricular filling pressures (E/e′) on echocardiography (r = −0.307, P = 0.014). Conclusions: This study adds further support to the concept of HFpEF as a disease of the vasculature, underlined by an increasing arterial stiffness that is driven by vascular ageing and accumulating vascular comorbidities, for example, hypertension and diabetes. Reflecting a pulsatile arterial afterload associated with diastolic dysfunction and exercise capacity, PWV may provide a clinically relevant tool to identify at‐risk intermediate phenotypes (e.g. pre‐HFpEF) before overt HFpEF occurs.
Item Type: | Journal Article | |||||||||
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Subjects: | R Medicine > RC Internal medicine | |||||||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Mental Health and Wellbeing Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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SWORD Depositor: | Library Publications Router | |||||||||
Library of Congress Subject Headings (LCSH): | Heart failure, Arteries, Comorbidity | |||||||||
Journal or Publication Title: | ESC Heart Failure | |||||||||
Publisher: | John Wiley & Sons Ltd | |||||||||
ISSN: | 2055-5822 | |||||||||
Official Date: | August 2023 | |||||||||
Dates: |
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Volume: | 10 | |||||||||
Number: | 4 | |||||||||
Page Range: | pp. 2487-2498 | |||||||||
DOI: | 10.1002/ehf2.14422 | |||||||||
Status: | Peer Reviewed | |||||||||
Publication Status: | Published | |||||||||
Access rights to Published version: | Open Access (Creative Commons) | |||||||||
Date of first compliant deposit: | 12 June 2023 | |||||||||
Date of first compliant Open Access: | 13 June 2023 | |||||||||
RIOXX Funder/Project Grant: |
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