Key result
New observational protocol will assess whether cf-PWV is higher during acute decompensation versus stable states.
Why the study?
Although increased arterial stiffness may precipitate ADHF or AKI, whether carotid-femoral pulse wave velocity is higher during acute hospitalization compared with stable compensated states remained to be evaluated.
Does arterial stiffness (measured by cf-PWV) vary between the acute decompensated phase of heart failure or acute kidney injury and the stable compensated phase 4 weeks post-discharge?
Cohort (n=120)
No
Does arterial stiffness (measured by cf-PWV) vary between the acute decompensated phase of heart failure or acute kidney injury and the stable compensated phase 4 weeks post-discharge?
This study protocol describes a prospective observational cohort study to assess changes in arterial stiffness between acute decompensation and stable states in patients with heart failure or acute kidney injury.
Whether cf-PWV rises in acute decompensation remains unknown; this protocol leaves the question open for prospective evaluation in HF and AKI.
INTRODUCTION: The cardiovascular (circulatory) system is a closed-loop system. The dynamic interaction of the heart and vascular system plays a pivotal role in maintaining adequate cardiac output. Heart failure (HF) is commonly described as a problem of the pump, that is, mechanical myocardial failure causing poor perfusion to the body. Still, the contribution of the vasculature is often neglected. Acute decompensated heart failure (ADHF) carries a poor prognosis and is often accompanied by concomitant chronic kidney disease (CKD) and acute kidney injury (AKI), which inevitably lead to adverse outcomes. The interaction of the heart with the vasculature is conceptualised as ventricular-vascular (arterial) coupling. Arterial stiffness, a non-traditional risk factor for cardiovascular disease, can be measured non-invasively using carotid-femoral pulse wave velocity (cf-PWV). High cf-PWV values mimicking increased arterial stiffness could be a causational factor towards precipitating ADHF or AKI. This study aims to assess whether cf-PWV is higher during the hospitalisation phase of patients with HF (ADHF) and CKD (AKI in CKD) compared with stable compensated HF and stable CKD. METHODS AND ANALYSIS: This prospective non-randomised observational study aims to recruit 120 patients aged≥60 years. Arterial stiffness will be assessed in three groups. These groups are decompensated HF with reduced ejection fraction (n=40), decompensated HF with preserved ejection fraction (n=40) and AKI in CKD stage 3a, 3b and 4, n=40. After 4 weeks from hospital discharge, patients in a stable, compensated state will be asked to attend a follow-up clinic visit to repeat the cf-PWV measurement. The primary outcome measure is variation in cf-PWV during hospitalisation against follow-up. ETHICS AND DISSEMINATION: Ethical approval was granted in October 2021 (REC reference 21/EM/0239), recruitment started in February 2022 and the results are expected in late 2025. The findings will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER: NCT05012722.
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Joshi et al. (2025) conducted a cohort in Acute decompensated heart failure and acute kidney injury (n=120). Hospitalisation phase (decompensated state) vs. Follow-up clinic visit (stable, compensated state) was evaluated on Variation in carotid-femoral pulse wave velocity (cf-PWV) during hospitalisation against follow-up. This study protocol outlines a prospective observational cohort study to assess whether arterial stiffness, measured by carotid-femoral pulse wave velocity, is higher during acute decompensation compared to a stable state.
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