The relationship between arterial stiffness and heart failure with preserved ejection fraction: a systemic meta-analysis

The objective is to investigate the relationship between arterial stiffness measured by arterial tonometry and echocardiographic indices of diastolic dysfunction-a basis for the diagnosis of heart failure with preserved ejection fraction (HFpEF). OvidSP Medline, Embase and PubMed were systematically searched. Eligible articles correlated arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV), carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx) or cardio-ankle vascular index (CAVI) with indices of diastolic dysfunction, E/A ratio, peak early mitral annular velocity (e') and E/e' ratio. Correlation coefficients were determined using a random-effects model. Twenty-seven studies with 6,626 patients were included. baPWV was significantly correlated with E/A ratio (r = -0.434, 95 % CI -0.387 to -0.479), e' (r = -0.499, 95 % CI -0.448 to -0.548) and E/e' ratio (r = 0.372, 95 % CI 0.251-0.481). cfPWV was significantly correlated with E/A ratio (r = -0.391, 95 % CI -0.304 to -0.470) and E/e' ratio (r = 0.210, 95 % CI 0.300-0.116), but not e'. AIx was significantly correlated with E/A ratio (r = -0.356, 95 % CI -0.255 to -0.450), e' (r = -0.313, 95 % CI -0.195 to -0.423) and E/e' ratio (r = 0.321, 95 % CI 0.250-0.388). CAVI was significantly correlated with E/A ratio (r = -0.405, CI -0.324 to -0.481), e' (r = -0.449, 95 % CI -0.340 to -0.630), but not E/e'. baPWV showed significantly greater correlation with diastolic dysfunction compared to most other tonometric techniques. Arterial stiffness measured by arterial tonometry is an indicator of diastolic dysfunction with baPWV demonstrated the most consistent and strongest association. These data suggest a refocusing on the impact of arterial stiffness on the left ventricle as a potential causative factor leading to HFpEF.