WAVE REFLECTIONS PROGNOSTIC UTILITY IN SYSTOLIC DYSFUNCTION

Ventricular-arterial stiffening is common in patients with heart failure and apparent preservation of systolic function. Such patients are typically older, female, hypertensive, and display a high prevalence of diabetes, obesity, and renal dysfunction. The aim of our study is to analyze the prognostic implications of central aortic pressure pulse waves in heart failure with reduced ejection fraction (HFrEF). Observational, prospective study that included 103 patients with stable heart failure with reduced ejection fraction (LVEF < 40%) and optimal medical treatment according to clinical practice guidelines. Risk factors, previous cardiovascular history and medical treatment were collected; physical examination, electrocardiography and echocardiography were carried out. The evaluation of the reflections of the arterial waves was performed non-invasively with the Sphygmocor Xcel® system calculating the following parameters: augmentation pressure (AP, mmHg), augmentation index (AIx, %) and carotid-femoral pulse wave velocity (cfPWV, m/s). A 6-months follow-up was performed, major adverse cardiovascular events (MACE) were collected (mortality, myocardial infarction, cerebrovascular disease or admission due to heart failure). The patient's average age was 68,15 ± 12,14 years, with 77.7% of males. 60% of them were hypertensive, 37.9% diabetic, and 68.9% dyslipidemic. LVEF average was 33.8 ± 6.7%. The most common etiologies of ventricular dysfunction were ischemic and idiopathic (65% and 26,2% respectively). During follow-up, 19.4% of patients suffered from a MACE. These patients presented lower values of the AP (11.30 ± 7.81 vs 15.38 ± 7.47 p = 0.032), and AIx (26.35 ± 15.96 vs 34.54 ± 12.92 p = 0.017), without differences in cfPWV. In the Cox regression model, an augmentation pressure more than 10mmHg was independently associated with low risk of events (HR: 0.378 [95% CI 0.147- 0.961]; p = 0.041), meanwhile high levels of NT-proBNP were associated with an increased risk of events (HR: 1.005 [95% CI 1.010-1.020]; p = 0.018). Our study suggests that the presence of an augmentation pressure higher than 10 mmHg determined non-invasively, is associated with a better evolution in patients with ventricular dysfunction. Further investigations are needed to determine the role of non-invasive vascular parameters in heart failure with reduced ejection fraction.