Abstract
Kim DB et al. Clin Cardiol. 2013;36:358–362.
To the Editor:
We read with interest the article “Improvement of Arterial Stiffness in the Transition From Acute Decompensated Heart Failure to Chronic Compensated Heart Failure” by Kim et al.1 They showed that central and upper‐extremity pulse wave velocity were increased in acute decompensated heart failure (HF) compared with chronic compensated HF. We believe these findings will be guides for further studies about the effect of prognosis on arterial stiffness parameters in patients with HF.
Arterial stiffness is a widely accepted marker of subclinical atherosclerosis. Arterial stiffness has received increased attention due to its role as an independent prognostic factor for hypertension, chronic kidney disease, diabetes, and systemic inflammatory diseases such as psoriasis.2 Increased arterial stiffness is a common indicator of atherosclerotic involvement of the vascular structure indicating coronary artery disease, cerebrovascular disease, and peripheral arterial disease. It is a noninvasive method to assess endothelial dysfunction in clinical practice.
Hypothyroidism plays a key role in cardiovascular disease pathogenesis as evidenced by increased augmentation of central aortic pressures and central arterial stiffness. It is increasingly apparent that stiffening of central arteries may lead to increased afterload and cardiac dysfunction.3 When arterial stiffness parameters were assessed with respect to their relationships with other studied parameters in patients, central aortic pressure showed significant relationships with serum vitamin B12 and phosphorus levels, whereas augmentation indexes had significant correlations, albumin, and magnesium levels.4
Impaired renal function may be associated with increased arterial stiffness. Reduced glomerular filtration rate (GFR) has been proposed as a useful integrated marker of subclinical target organ damage and increased cardiovascular risk. The GFR provides more sensitive information about renal function than the serum creatinine level. The GFR can be measured via the formula of modification of diet in renal disease and Cockcroft‐Gault equation.
In conclusion, although arterial stiffness is a novel, simple, inexpensive, and noninvasive method to evaluate endothelial dysfunction in clinical practice, it may be affected by many conditions. Therefore, without other inflammatory markers, arterial stiffness alone may not provide information to clinicians about the prognosis in patients with HF.
Sait Demirkol, MD Sevket Balta, MD Ugur Kucuk, MD Murat Unlu, MD Department of Cardiology, Gulhane Medical Academy Mustafa Cakar, MD Mustafa Dinc, MD Department of Internal Medicine, Beytepe Hospital Ankara, Turkey
References
- 1. Kim DB, Baek SH, Jang SW, et al. Improvement of arterial stiffness in the transition from acute decompensated heart failure to chronic compensated heart failure. Clin Cardiol. 2013;36:358–362. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Balta I, Balta S, Demirkol S, et al. Aortic arterial stiffness is a moderate predictor of cardiovascular disease in patients with psoriasis vulgaris [published online ahead of print May 1, 2013]. Angiology. 2013. doi: 10.1177/0003319713485805. [DOI] [PubMed] [Google Scholar]
- 3. Obuobie K, Smith J, Evans LM, et al. Increased central arterial stiffness in hypothyroidism. J Clin Endocrinol Metab. 2002;87:4662–4666. [DOI] [PubMed] [Google Scholar]
- 4. Altun B, Bulucu F, Demirbas S, et al. The relationship between some of the cardiovascular risk factors and arterial stiffness parameters in essentially hypertensive patients [published online ahead of print November 29, 2012]. Clin Exp Hypertens. doi: 10.3109/10641963.2012.746354. [DOI] [PubMed]