Beyond the linear continuum: a pulse wave velocity transition zone identifies patients at high risk for elevated LV filling pressures
O Torbas, S Prohonov, O Rekovets, G Radchenko, O SirenkoAbstract
Background
Arterial stiffness is a well-known factor for (LV) diastolic dysfunction progression. Although this is usually seen as a gradual continuum, we hypothesized that a clinically relevant transition zone may exist, where increasing arterial stiffness is associated with a disproportionate rise in LV filling pressures. We decided to identify an optimal pulse wave velocity (PWV) range associated with elevated LV filling pressures.
Methods
We used PULSE-COR registry data. We included a cohort of 1,145 consecutive patients, 296 underwent simultaneous vascular (PWV) and echocardiographic assessment. We used SphygmoCor device (AtCor, Australia) for the determination carotid-femoral pulse wave velocity (cfPWV). Central blood pressure and pulse wave velocity were additionally obtained using a validated Ukrainian device (BAT 41-2, IKS Techno), previously shown to demonstrate high agreement with SphygmoCor, enabling simultaneous acquisition of PWV during the echocardiographic exam. Elevated LV filling pressure was defined as E/E’avg ≥14. We used ROC analysis to identify the PWV value best associated with elevated filling pressure and performed multivariable logistic regression adjusting for age, left atrial volume index (LAVI), and LV mass index (LVMI). To assess the robustness of the findings, we conducted sensitivity analyses and 500-iteration bootstrap validation.
Results
PWV showed a moderate correlation with age (ρ=0.52, p<0.001). When analyzed by quartiles, E/E’avg remained relatively stable across the first three PWV quartiles (6.7–7.4) and increased substantially in the highest quartile (10.35; p<0.001). ROC analysis suggested 14.4 m/s as the PWV value most strongly associated with elevated filling pressure (AUC 0.72). After adjustment for age, LAVI and LVMI, a PWV value ≥14.4 m/s remained strongly associated with elevated LV filling pressure (OR 9.3; 95% CI 2.8–30.7; p<0.001). The association persisted when alternative cut-offs within the 13.5–15.0 m/s range were tested and showed similar magnitude in bootstrap analysis (median OR 8.9).
Conclusions
The association between arterial stiffness and LV filling pressure appears to be characterized by a threshold-like pattern, with a distinct high-risk PWV range around 14–15 m/s. This vascular phenotype identifies a subgroup of patients with disproportionate elevation in filling pressures, independent of age and structural remodeling, and may refine risk stratification within the HFpEF continuum.ROC Curve: PWVel and LV Filling PressureAdjusted Risk Of Elevated LV Filling Pressure