title: Increased aortic pulse wave velocity as measured by echocardiography is strongly associated with poor prognosis in patients with heart failure.
abstract: BACKGROUND
  An increased aortic pulse wave velocity (PWV), a marker of arterial stiffness, is associated with poor prognosis in various diseases. In patients with heart failure (HF), an increased aortic PWV is associated with low peak exercise oxygen consumption, which is a strong risk factor of adverse clinical outcomes. However, it remains unknown if an increased aortic PWV predicts poor prognosis in patients with HF, independent of peak exercise oxygen consumption.
  
  
  RESULTS
  We enrolled 156 patients with HF and left ventricular ejection fraction <45%, who were followed up for a mean (SD) period of 36 ± 19 months. At baseline, all the patients underwent a complete echocardiography with aortic PWV as measured by Doppler ultrasonography and peak exercise oxygen consumption as measured by bicycle exercise testing with expiratory gas exchange monitoring. During the follow-up period, 20 patients (12.8%) died and 15 patients (9.6%) were hospitalized for worsening HF. In the Kaplan-Meier analysis, patients in the first tertile of aortic PWV had a lower risk of developing cardiac death or hospitalization (combined end point) than those in the second and third tertile combined (P < .001). In Cox regression analysis, increased aortic PWV (both as a continuous and categorical variable) was significantly associated with an increased risk of adverse clinical outcomes after adjustment for peak exercise oxygen consumption and other clinical risk factors (P < .05).
  
  
  CONCLUSIONS
  Increased aortic PWV, as measured by echocardiography, independently predicted adverse clinical outcomes (cardiac death or hospitalization) among patients with HF.
authors.affiliation: Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Bonapace
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Mariantonietta
authors.initials: M
authors.lastname: Cicoira
authors.forename: Giovanni
authors.initials: G
authors.lastname: Targher
authors.forename: Filippo
authors.initials: F
authors.lastname: Valbusa
authors.forename: Athanase
authors.initials: A
authors.lastname: Benetos
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
mesh_terms: D000368:Aged; D001011:Aorta / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D016009:Chi-Square Distribution; D015150:Echocardiography, Doppler; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D010101:Oxygen Consumption; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012307:Risk Factors