Arterial Stiffness Is an Important Predictor of Heart Failure with Preserved Ejection Fraction (HFpEF)—The Effects of Phosphate Retention
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Subjects
2.2. Echocardiography
2.3. Assessments of Pulse Wave Velocity and Central Blood Pressure Measurements
2.4. Thoracic Aortic Calcification (TAC) Scores
2.5. Blood Chemistry Measurements
2.6. Bone Mineral Density (BMD)
2.7. Statistical Analysis
3. Results
3.1. Clinical Characteristics
3.2. Correlations between Each Parameter
3.3. Regression Analyses
4. Discussion
5. Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | HFpEF Group (n = 52) | Non-HFpEF Group (n = 106) | p Value |
---|---|---|---|
Age, years | 82.0 ± 6.6 | 71.3 ± 11.4 | <0.0001 |
Sex, male, n (%) | 16 (30.8%) | 52 (49.1%) | 0.029 |
Body mass index, kg/m2 | 23.5 ± 4.2 | 23.1 ± 3.8 | 0.51 |
Systolic blood pressure, mmHg | 132.0 ± 16.8 | 125.1 ± 18.2 | 0.024 |
Diastolic blood pressure, mmHg | 68.4 ± 12.4 | 71.3 ± 11.2 | 0.14 |
Heart rate, beats/min | 73.9 ± 15.9 | 73.0 ± 14.7 | 0.72 |
Pulse pressure, mmHg | 63.6 ± 14.6 | 53.7 ± 14.7 | <0.001 |
-Blood tests | |||
Albumin, g/dL | 3.6 ± 0.6 | 4.0 ± 0.4 | <0.0001 |
Glucose, mg/dL | 103 (87, 113) | 106 (94,127) | 0.07 |
Hemoglobin A1c, % | 5.9 (5.6, 6.4) | 6.0 (5.6, 6.7) | 0.46 |
Creatinine, mg/dL | 1.1 ± 0.8 | 0.9 ± 0.3 | 0.014 |
BUN, mg/dL | 22.3 ± 10.7 | 18.5 ± 8.9 | <0.001 |
eGFR, mL/min/1.73 m2 | 51.9 ± 17.1 | 62.5 ± 19.3 | <0.001 |
Total cholesterol, mg/dL | 187 (148, 215) | 187 (163, 210) | 0.67 |
LDL-cholesterol, mg/dL | 91 (72, 117) | 99 (76, 120) | 0.64 |
HDL-cholesterol, mg/dL | 63 (45, 82) | 61 (50, 75) | 0.56 |
Triglycerides, mg/dL | 100 (79, 134) | 112 (85, 159) | 0.17 |
AST, U/L | 22 (19, 29) | 22 (18, 27) | 0.38 |
ALT, U/L | 14 (10, 20) | 14 (10, 22) | 0.33 |
γGTP, U/L | 22 (15, 40) | 26 (17, 45) | 0.40 |
LDH, U/L | 225 (173, 275) | 166 (150, 184) | <0.0001 |
ALP, U/L | 181 (90, 246) | 127 (72, 223) | 0.14 |
hs-CRP, mg/dL | 0.21 (0.06, 0.61) | 0.08 (0.04, 0.19) | 0.007 |
Leukocyte,/µL | 5350 (4100, 6100) | 5500 (4500, 6400) | 0.29 |
Hemoglobin, g/dL | 11.4 ± 1.9 | 13.5 ± 1.8 | <0.0001 |
Platelets, ×104/μL | 20.3 ± 7.8 | 21.3 ± 6.4 | 0.42 |
PTH (intact), pg/mL | 50.0 (35.0, 70.5) | 39.0 (29.0, 55.0) | 0.07 |
1,25(OH)2VD, (VD3), pg/mL | 34.0 (27.0, 46.0) | 48.0 (37.0, 59.0) | <0.010 |
FGF23, pg/mL | 51.2 (34.7, 79.8) | 42.6 (34.6, 48.7) | 0.042 |
Calcium, mg/dL | 8.8 ± 0.5 | 9.0 ± 0.5 | 0.07 |
Phosphate, mg/dL | 3.51 ± 0.52 | 3.51 ± 0.46 | 0.97 |
Magnesium, mg/dL | 2.22 ± 0.28 | 2.23 ± 0.17 | 0.96 |
BNP, pg/mL | 145.4 (73.5, 343.2) | 26.7 (13.4, 60.1) | <0.0001 |
Sinus | 77.9 (60.9, 126.1) | 23.7 (12.7, 50.9) | <0.0001 |
Af | 267.0 (145.5, 491.9) | 50.1 (36.8, 176.9) | <0.0001 |
-Thoraxic CT (Calcification) | |||
Thoraxic Agatston score, HU | 4182 (874, 9532) | 1372 (322, 4213) | 0.003 |
Calcification volume score, HU | 5666 (1291, 11,479) | 1930 (436, 5669) | 0.004 |
-Central blood pressure index | |||
Reflection magnitude, % | 65 (60, 72) | 67 (59, 74) | 0.60 |
Augmentation press., mmHg | 10 (6, 13) | 7 (4, 15) | 0.039 |
Augmentation index, % | 25 (19, 33) | 20 (11, 37) | 0.029 |
PWV, m/s | 12.3 (10.9, 13.1) | 10.2 (9.1, 11.8) | <0.0001 |
Central SBP, mmHg | 121.1 ± 16.6 | 110.0 ± 16.5 | <0.001 |
Central DBP, mmHg | 77.3 ± 14.8 | 75.6 ± 12.5 | 0.46 |
Central pulse pressure, mmHg | 43.7 ± 13.5 | 34.5 ± 10.3 | <0.0001 |
-Cardiac echo | |||
LVDd, mm | 43.0 ± 5.5 | 42.0 ± 5.2 | 0.27 |
LVDs, mm | 27.2 ± 4.8 | 26.5 ± 4.9 | 0.40 |
IVST, mm | 10.5 ± 1.6 | 9.8 ± 1.5 | 0.006 |
PWT, mm | 10.3 ± 1.7 | 9.5 ± 1.5 | 0.005 |
LVMI, g/m2 | 102 (80, 118) | 81 (69, 96) | <0.0001 |
Relative wall thickness | 0.46 (0.41, 0.55) | 0.42 (0.40, 0.46) | 0.002 |
Septal e′ | 5.2 (4.3, 6.0) | 7.2 (6.1, 9.0) | <0.0001 |
Septal E/e′ ratio | 16.0 (15.3, 17.6) | 10.0 (8.1, 11.6) | <0.0001 |
TR velocity, m/sec | 2.7 (2.6, 3.0) | 2.4 (2.2, 2.6) | <0.0001 |
LVEF (teichholz), % | 67.3 (61.0, 72.6) | 68.4 (63.0, 72.7) | 0.53 |
E/A ratio, | 0.81 ± 0.37 | 0.77 ± 0.25 | 0.49 |
Dct time, mmsec | 221.8 ± 90.3 | 226.5 ± 56.0 | 0.69 |
LA dimension, mm | 41.4 ± 8.6 | 34.0 ± 6.4 | <0.0001 |
-Smoking habit | |||
Habitual smoking, n (%) | 12/41 (29.3%) | 37/82 (45.1%) | 0.09 |
-Complications | |||
Hypertension, n (%) | 39 (75.0%) | 61(57.5%) | 0.032 |
Diabetes mellitus, n (%) | 13 (28.8%) | 24 (22.6%) | 0.40 |
Hyperlipidemia, n (%) | 10 (19.2%) | 26 (24.5%) | 0.46 |
Af history, n (%) | 28 (53.8%) | 21 (19.8%) | <0.0001 |
Variables | Male (n = 68) | Female (n = 90) | p Value |
---|---|---|---|
Age, years | 72.4 ± 12.8 | 76.7 ± 9.6 | 0.017 |
Body mass index, kg/m2 | 24.0 ± 3.1 | 22.7 ± 3.1 | 0.044 |
Systolic blood pressure, mmHg | 127.0 ± 18.9 | 127.7 ± 17.7 | 0.81 |
Diastolic blood pressure, mmHg | 71.8 ± 12.1 | 69.2 ± 11.2 | 0.18 |
Heart rate, beats/min | 71.1 ± 14.0 | 74.8 ± 15.6 | 0.14 |
Pulse pressure, mmHg | 55.2 ± 15.5 | 58.4 ± 15.2 | 0.19 |
-Blood tests | |||
Albumin, g/dL | 3.9 ± 0.5 | 3.8 ± 0.5 | 0.30 |
Glucose, mmol/L | 110 (97, 129) | 99 (91,113) | 0.006 |
Hemoglobin A1c, % | 6.2 (5.6, 6.9) | 5.9 (5.6, 6.1) | 0.10 |
Creatinine, mg/dL | 1.1 ± 0.5 | 0.9 ± 0.5 | 0.024 |
BUN, mg/dL | 18.5 ± 8.8 | 20.7 ± 10.2 | 0.15 |
eGFR, | 59.8 ± 16.4 | 58.5 ± 21.1 | 0.68 |
Total cholesterol, mmol/L | 172 (149, 198) | 199 (166, 215) | 0.002 |
LDL-cholesterol, mmol/L | 93 (68, 113) | 101 (82, 123) | 0.11 |
HDL-cholesterol, mmol/L | 53 (41, 67) | 69 (59, 82) | <0.0001 |
Triglycerides, mmol/L | 111 (99, 144) | 104 (77, 143) | 0.35 |
AST, U/L | 23 (19, 29) | 22 (18, 26) | 0.31 |
ALT, U/L | 17 (13, 26) | 12 (9, 17) | <0.001 |
γGTP, U/L | 39 (28, 61) | 20 (14, 28) | <0.0001 |
LDH, U/L | 174 (150, 214) | 181 (159, 215) | 0.29 |
ALP, U/L | 145 (70, 242) | 166 (89, 245) | 0.16 |
hs-CRP, mg/dL | 0.14 (0.06, 0.35) | 0.09 (0.03, 0.22) | 0.042 |
Leukocyte,/µL | 5500 (4400, 6500) | 5400 (4400, 6100) | 0.35 |
Hemoglobin, g/dL | 13.6 ± 2.4 | 12.2 ± 1.5 | <0.0001 |
Platelets, ×104/μl | 20.0 ± 6.4 | 21.7 ± 7.2 | 0.15 |
PTH (intact), pg/mL | 41.5 (30.0, 56.0) | 40.0 (31.0, 64.0) | 0.81 |
1,25(OH)2VD, (VD3), pg/mL | 41.0 (30.0, 57.0) | 44.0 (30.0, 58.0) | 0.91 |
FGF23, pg/mL | 42.9 (37.5, 52.3) | 45.0 (33.6, 73.8) | 0.42 |
Calcium, mg/dL | 8.8 ± 0.4 | 9.0 ± 0.5 | 0.08 |
Phosphate, mg/dL | 3.36 ± 0.44 | 3.60 ± 0.50 | 0.016 |
Magnesium, mg/dL | 2.23 ± 0.17 | 2.23 ± 0.24 | 0.97 |
BNP, pg/mL | 38.2 (19.7, 101.3) | 60.9 (19.0, 134.9) | 0.27 |
Sinus | 24.7 (14.2, 60.1) | 34.9 (14.4, 85.0) | 0.23 |
Af | 175.4 (50.7, 345.6) | 176.9 (63.4, 391.5) | 0.63 |
-Thoraxic CT (Calcification) | |||
Thoraxic Agatston score, HU | 3333 (1207, 8622) | 1956 (369, 5486) | 0.26 |
Calcification volume score, HU | 4558 (1093, 8622) | 2543 (550, 7174) | 0.21 |
-Central blood pressure index | |||
Reflection magnitude, % | 65 (59, 70) | 69 (61, 75) | 0.025 |
Augmentation press., mmHg | 7.0 (4.0, 12.5) | 8.0 (5.0, 17.0) | 0.032 |
Augmentation index, % | 17.0 (9.0, 30.0) | 24.5 (17.0, 38.0) | 0.001 |
PWV, m/s | 10.5 (9.5, 12.5) | 11.2 (9.9, 12.6) | 0.12 |
Central SBP, mmHg | 112.7 ± 17.4 | 112.7 ± 17.0 | 0.47 |
Central DBP, mmHg | 78.9 ± 12.8 | 74.0 ± 13.0 | 0.018 |
Central pulse pressure, mmHg | 55.2 ± 15.5 | 58.4 ± 15.2 | 0.19 |
-Cardiac echo | |||
LVDd, mm | 45.0 ± 4.2 | 40.3 ± 5.2 | <0.0001 |
LVDs, mm | 29.2 ± 4.5 | 25.0 ± 4.3 | <0.0001 |
IVST, mm | 10.3 ± 1.5 | 9.8 ± 1.6 | 0.023 |
PWT, mm | 10.2 ± 1.6 | 9.5 ± 1.5 | 0.006 |
LVMI, g/m2 | 93.5 (77.9, 107.0) | 80.5 (71.3, 100.0) | 0.028 |
Relative wall thickness | 0.42 (0.40, 0.47) | 0.44 (0.40, 0.49) | 0.11 |
Septal e′ | 6.5 (5.8, 9.0) | 6.0 (4.8, 7.3) | 0.006 |
Septal E/e′ ratio | 10.8 (8.0, 15.2) | 12.4 (9.6, 15.5) | 0.029 |
TR velocity | 2.5 (2.3, 2.9) | 2.6 (2.3, 2.8) | <0.0001 |
LVEF (teichholz), % | 65.9 (59.3, 71.5) | 69.1 (64.0, 74.7) | 0.53 |
E/A ratio, | 0.83 ± 0.34 | 0.75 ± 0.23 | 0.14 |
Dct time, mmsec | 215.4 ± 66.8 | 232.1 ± 70.1 | 0.13 |
LA dimension, mm | 37.5 ± 8.0 | 35.6 ± 7.9 | 0.14 |
-Smoking habit | |||
Habitual smoking, n (%) | 41 (60.3 %) | 8 (8.9 %) | <0.0001 |
-Complications | |||
HFpEF, n (%) | 16 (23.5 %) | 36 (40.0 %) | 0.029 |
Hypertension, n (%) | 38 (55.9 %) | 62 (68.9 %) | 0.09 |
Diabetes mellitus, n (%) | 23 (33.8 %) | 16 (17.8 %) | 0.021 |
Hyperlipidemia, n (%) | 11 (16.2%) | 25 (27.8 %) | 0.09 |
Af history, n (%) | 22 (32.4 %) | 27 (30.0 %) | 0.75 |
Osteoporosis, n (%) | 7/24 (29.2%) | 33/52 (63.5%) | 0.005 |
Hip total BMD, 0.75(YAM80%) | 87.2 ± 20.1 | 68.2 ± 17.1 | <0.0001 |
HFpEF | Coef. | Std. Err. | t | p > |t| | 95% Conf. Interval | |
---|---|---|---|---|---|---|
PWV | 0.11133 | 0.01573 | 7.08 | <0.001 | 0.0803 | 0.1424 |
Age | 0.01871 | 0.00300 | 6.23 | <0.001 | 0.0128 | 0.0246 |
Central systolic BP | 0.00822 | 0.00210 | 3.92 | <0.001 | 0.0041 | 0.0124 |
eGFR | −0.00713 | 0.00188 | −3.79 | <0.001 | −0.0108 | −0.0034 |
Agatston score | 0.00003 | 0.00001 | 2.98 | 0.004 | 0.0000 | 0.0001 |
Sex (male) | −0.16471 | 0.07830 | −2.20 | 0.029 | −0.3125 | −0.1670 |
Serum FGF23 | 0.00353 | 0.00160 | 2.20 | 0.030 | 0.0003 | 0.0067 |
Hypertension | 0.16586 | 0.07691 | 2.16 | 0.033 | −0.0394 | 0.3178 |
Serum vitamin D3 | −0.00432 | 0.00202 | −2.15 | 0.034 | −0.0083 | −0.0003 |
Parathyroid hormone | 0.00253 | 0.00152 | 1.66 | 0.099 | −0.0005 | 0.0056 |
Diabetes mellitus | 0.07369 | 0.08706 | 0.85 | 0.399 | −0.0983 | 0.2456 |
Body mass index | 0.00623 | 0.00951 | 0.65 | 0.514 | −0.0126 | 0.0250 |
HFpEF | Coef. | Std. Err. | t | p > |t| | 95% Conf. Interval | |
---|---|---|---|---|---|---|
Higher PWV value | 0.39451 | 0.06696 | 5.89 | <0.001 | 0.2622 | 0.5270 |
Hypertension | 0.15155 | 0.06972 | 2.17 | 0.031 | 0.0132 | 0.2893 |
Sex (male) | −0.10425 | 0.06823 | −1.53 | 0.129 | −0.2390 | 0.0305 |
-cons | −0.08095 | 0.07505 | 1.08 | 0.283 | −0.0674 | 0.2291 |
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Mizuno, Y.; Ishida, T.; Tsujita, K.; Yoshimura, M. Arterial Stiffness Is an Important Predictor of Heart Failure with Preserved Ejection Fraction (HFpEF)—The Effects of Phosphate Retention. Hearts 2024, 5, 211-224. https://doi.org/10.3390/hearts5020014
Mizuno Y, Ishida T, Tsujita K, Yoshimura M. Arterial Stiffness Is an Important Predictor of Heart Failure with Preserved Ejection Fraction (HFpEF)—The Effects of Phosphate Retention. Hearts. 2024; 5(2):211-224. https://doi.org/10.3390/hearts5020014
Chicago/Turabian StyleMizuno, Yuji, Toshifumi Ishida, Kenichi Tsujita, and Michihiro Yoshimura. 2024. "Arterial Stiffness Is an Important Predictor of Heart Failure with Preserved Ejection Fraction (HFpEF)—The Effects of Phosphate Retention" Hearts 5, no. 2: 211-224. https://doi.org/10.3390/hearts5020014
APA StyleMizuno, Y., Ishida, T., Tsujita, K., & Yoshimura, M. (2024). Arterial Stiffness Is an Important Predictor of Heart Failure with Preserved Ejection Fraction (HFpEF)—The Effects of Phosphate Retention. Hearts, 5(2), 211-224. https://doi.org/10.3390/hearts5020014