Clinical Significance of Cardio-Ankle Vascular Index in Stage A/B Heart Failure Patients With Type 2 Diabetes Mellitus

Abstract

Background: Heart failure (HF) is a medical condition with a poor prognosis; therefore, it is important to consider treatment strategies from the pre-onset stage, i.e., at stage A/B HF. However, in addition to type 2 diabetes mellitus (T2DM) being a risk factor for HF, it has also been reported that the prognosis of HF is worse among patients with T2DM than among those without it. This cross-sectional study aimed to clarify the clinical significance of the cardio-ankle vascular index (CAVI), an indicator of arterial stiffness, in stage A/B HF patients with T2DM.

Methods: In total, 292 stage A/B HF patients (113 men and 179 women) with T2DM were enrolled, and the relationships between CAVI and various clinical parameters were evaluated. Furthermore, cut-off values of CAVI and brain natriuretic peptide (BNP) for distinguishing between stage A HF and stage B HF were determined using a receiver operating characteristic curve, and these two markers were employed in combination to distinguish stage A HF from stage B HF.

Results: CAVI was significantly associated with various parameters in this study. Among them, multiple regression analyses indicated that 11 explanatory factors (calf circumference, renin-angiotensin system inhibitors use, E/e' ratio, skin autofluorescence, subendocardial viability ratio, glucagon-like peptide-1 receptor agonists use, age, decreased estimated glomerular filtration rate, coronary artery disease, stage B HF, and sodium-glucose cotransporter 2 inhibitors use) were selected as independent variables for CAVI as the dependent variable (R² = 0.663). However, CAVI and BNP thresholds for distinguishing stage A HF from stage B HF using the receiver operating characteristic curve were 9.0 and 34.0 pg/mL, respectively. In addition, compared to patients with low CAVI (≤ 9.0) and low BNP (≤ 34.0 pg/mL), those with high levels of both factors (CAVI > 9.0, BNP > 34.0 pg/mL) showed a 9.72-fold higher odds ratio (95% confidence interval: 3.24–19.92, P < 0.001).

Conclusion: CAVI is significantly associated with early-stage HF in T2DM patients. Combining CAVI and BNP may provide a useful screening tool for subclinical HF risk stratification, although further prospective studies are required to elucidate causal relationships.