Significance of CAVI as a Functional Stiffness Parameter

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suggests that CAVI is not affected by immediate changes in BP, while decreasing with vascular smooth muscle relaxation.In this issue of JACC: Advances, Tavolinejad et al 3 report on a meta-analysis examining the prognostic value of CAVI.The systematic review included 32 studies (N ¼ 105,845) and demonstrated that the baseline CAVI was independently associated with future cardiovascular (CV) and kidney outcomes.Notably, the prognostic value of CAVI was confirmed in a multinational setting and was present even when limited to the primary prevention group.
The role of CAVI as a structural stiffness parameter is well established, and many prospective studies have proposed a CAVI of 9.0 or higher as the optimal cutoff to predict CV disease (CVD). 4CAVI has recently been shown to have significance beyond its prognostic value for CV events (Figure 1).The present editorial highlights new horizons for vascular function research utilizing CAVI.
The proposed pathophysiology is that vasa vasorum and medial smooth muscle contraction, indicated by a rapid rise in CAVI, are involved in plaque rupture. 5Shimizu et 5 al reported that healthy individuals showed a transient increase in CAVI immediately after the Great East Japan Earthquake in 2011.An increase in CV events and mortality was observed during the same period, suggesting that psychological stress might have triggered CV events via rapid deterioration of vascular function.Furthermore, cases of myocardial infarction, cerebral hemorrhage, or aortic dissection following a short-term upward trend in CAVI have also been reported, respectively.It is speculated that a rapid rise in CAVI means medial smooth muscle contraction and strangling vasa vasorum, lead to ischemia of vulnerable plaque.An increase in CAVI of more than 0.5 over a 6month may be a warning sign.CAVI is considered to reflect not only structural stiffness but also functional stiffness and should be continuously monitored in individuals with CVD risks.
The value of CAVI in daily clinical practice is not limited to predicting CV events.CAVI reflects the severity of CV risks including glucose intolerance, hypertension, dyslipidemia, sleep apnea, and smoking. 4Additionally, appropriate therapeutic interventions can reduce CAVI, suggesting that CAVI can help assess vascular injury and therapeutic ef- Furthermore, the increase in CAVI associated with decreased circulating plasma volume is further evidence to supporting interactions.In hemodialysis patients, blood removal causes a transient increase in

FUNDING SUPPORT AND AUTHOR DISCLOSURES
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
fects.Metabolic syndrome (MetS) is also associated with increased CAVI, while, contrary to intuition, body mass index and waist circumference (WC) are known to have an inverse relationship withCAVI. 6 This obesity paradox may be because body mass index and WC preferentially reflect vascular protective ISSN 2772-963X https://doi.org/10.1016/j.jacadv.2024.101018body composition such as subcutaneous fat and/or skeletal muscle mass.We have reported that "a body shape index (ABSI)" is the abdominal obesity index most strongly associated with vascular injury, that is, increased CAVI, attributable to abdominal obesity.In addition, ABSI reflects not only visceral fat accumulation but also sarcopenia and is associated with CAVI independently of conventional metabolic parameters.It has also been shown that adopting high ABSI instead of high WC for MetS diagnosis reinforces the identification of individuals at risk for high CAVI and kidney function decline.This modification of the ABSI-based MetS diagnostic criteria will eventually need to be validated also in terms of CVD risk assessment.Finally, we emphasize the significance of CAVI as an assessment tool for ventricular-arterial interaction.The independency of CAVI from BP at the measuring time allows real-time assessment of vascular alterations in response to hemodynamic change.Several studies shown that elevated CAVI is independently associated with left ventricular diastolic dysfunction in individuals with preserved systolic function. 7Zhang et al 8 reported that the decrease in CAVI was associated with the increase in left ventricular ejection fraction in individuals recovering from acute heart failure.These findings suggest that increased left ventricular afterload, as indicated by increased CAVI, is a reversible regulator for cardiac dysfunction.In addition, ventriculararterial interaction may also be mediated by pulmonary arterial hypertension.Sato et al 9 reported that pulmonary angioplasty for chronic thromboembolic pulmonary hypertension reduces CAVI.The change in CAVI after the angioplasty was associated not only with the change in mean pulmonary artery pressure but also with changes in biventricular volumes, that is, cardiac remodeling.This suggests that chronic thromboembolic pulmonary hypertensioninduced pathophysiology including hypoxia, left ventricular compression, and pulmonary hypertension may affect the ventricular-arterial interaction.

FIGURE 1
FIGURE 1 Significance of CAVI Beyond Prognostic Value of Cardiovascular Events