Arterial Stiffness is an Important Predictor of Heart Failure with Preserved Ejection Fraction - The Effects of Phosphate Retention-

BACKGROUNDHeart failure with preserved ejection fraction (HFpEF) is a major health concern. There is a growing recognition of the causal interplay between arterial stiffness and HFpEF. We recently reported that the deterioration of phosphate homeostasis is a trigger for both arterial stiffness. This study focuses on whether arterial stiffness due to phosphate retention could be a predictor for HFpEF. METHODSThe study subjects were 158 patients (68 males and 90 females, mean age 74.8{+/-}11.2). They received echocardiography, central blood pressure (BP) and blood biochemistry tests. HFpEF was defined according to the guidelines of the European Society of Cardiology 2021. Pulse wave velocity (PWV) and central systolic blood pressure (CSBP) were used as markers for arterial stiffness and cardiac afterload, respectively. We measured serum levels of fibroblast growth factor 23 (FGF23) as markers of phosphate retention. RESULTSThe serum levels of FGF23 had significant relationship with PWV (t=3.33, p<0.001). PWV had a significant positive relationship with CSBP (t=4.54, p<0.001). PWV furthermore had significant relationships with LV mass index (t=4.74), plasma BNP levels (t=5.44), and relative wall thickness (t=3.83), e (t=-4.21) and E/e (t=7.88) (p<0.001, respectively). Multivariate logistic regression analysis using independent factors, including PWV higher values, sex and hypertension, revealed that PWV higher values (t=5.89, p<0.0001) and hypertension (t=2.17, p=0.031) were significant predictors for the dependent factor (HFpEF). CONCLUSIONSArterial stiffness amplified cardiac afterload, leading to LV concentric hypertrophy and LV diastolic dysfunction. This study presents that arterial stiffness due to phosphate retention, and hypertension are important predictors of HFpEF. What is New?Arterial stiffness is an important predictor for HFpEF. Arterial stiffness is caused by an increase in phosphate retention due to aging and CKD via kidney nephron loss. Arterial stiffness amplifies cardiac afterload leading to LV concentric hypertrophy and LV diastolic dysfunction. What are the Clinical Implications?Arterial calcification and/or stiffness should be a new target in cardiovascular diseases. Phosphate is thought to be an important aging accelerating factor. Phosphate regulating medications, phosphate restriction diets, and osteoporosis therapies may all be protective against aging related diseases including HFpEF.