Association between Cardio-Ankle Vascular Index and Heart Failure Outcomes: Insights from a Prospective Multicenter Cohort

Heart failure (HF) is a substantial public health concern associated with poor prognosis and limited tools for early prediction. Arterial stiffness contributes to the development of HF, particularly with a preserved ejection fraction. The cardio-ankle vascular index (CAVI) is a noninvasive, pressure-independent marker of arterial stiffness. However, its prognostic value in HF remains unclear. We aimed to evaluate whether CAVI independently predicts HF-related hospitalizations in patients with cardiovascular risk factors and whether it adds prognostic value beyond conventional risk factors. This sub-analysis of the multicenter prospective CAVI-J study included 2,932 Japanese adults aged 40-74 years with cardiovascular risk factors. Participants were stratified into CAVI tertiles and followed up for a median of 4.9 years. The primary outcomes were HF-related hospitalizations and cardiovascular death. Cox proportional hazards models were used to assess the risk, and the incremental prognostic value was evaluated using global chi-squared statistics and reclassification indices. Primary outcomes were recorded in 32 patients (1.1%). High CAVI (≥9.0) was independently associated with increased risk (hazard ratio 3.18, 95% confidence interval: 1.09-9.31; P = 0.034). When CAVI was added to a model with known conventional risks, the global chi value increased from 8.82 to 18.77 (P = 0.002), and the net reclassification index was 0.621 (P < 0.001). Elevated CAVI independently associated with HF-related hospitalizations and cardiovascular death and modestly improved risk prediction beyond conventional risk factors. However, the discriminative ability remained limited, and further studies are warranted to establish its clinical utility.