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ABSTRACT

Background Heart failure (HF) is a substantial public health concern associated with poor prognosis and limited tools for early prediction. Arterial stiffness contributes to the development of HF, particularly with a preserved ejection fraction. The cardio-ankle vascular index (CAVI) is a noninvasive, pressure-independent marker of arterial stiffness. However, its prognostic value in HF remains unclear. Objectives We aimed to evaluate whether CAVI independently predicts HF-related hospitalizations in patients with cardiovascular risk factors and whether it adds prognostic value beyond conventional risk factors. Methods This subanalysis of the multicenter prospective CAVI-J (Prospective Multicenter Study to Evaluate Usefulness of CAVI in Japan) study included 2,932 Japanese adults aged 40 to 74 years with cardiovascular risk factors. Participants were stratified into CAVI tertiles and followed up for a median of 4.9 years. The primary outcomes were HF-related hospitalizations and cardiovascular death. Cox proportional hazards models were used to assess the risk, and the incremental prognostic value was evaluated using global chi-square statistics and reclassification indices. Results Primary outcomes were recorded in 32 patients (1.1%). High CAVI (≥9.0) was independently associated with an increased risk (HR: 3.18; 95% CI: 1.09-9.31; P = 0.034). When CAVI was added to a model with known conventional risks, the global chi value increased from 8.82 to 18.77 (P = 0.002), and the net reclassification index was 0.621 (P < 0.001). Conclusions In this exploratory study, elevated CAVI was associated with HF-related hospitalizations and cardiovascular death and modestly improved the risk prediction beyond conventional risk factors. However, the discriminative ability remained limited, and further studies are warranted to establish its clinical utility.

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