Arterial Stiffness Is an Important Predictor of Heart Failure
with Preserved Ejection Fraction (HFpEF)—The Effects of
Phosphate Retention
Yuji Mizuno 1,2,* , Toshifumi Ishida 1,3, Kenichi Tsujita 3 and Michihiro Yoshimura 4
1 Division of Cardiovascular Medicine, Kumamoto Aging Research Institute, Kumamoto 860-8518, Japan;
ishida-t@kumamoto-u.ac.jp
2 Division of Cardiovascular Medicine, Mizuno Heart Clinic, Koshi 861-1115, Japan
3 Department of Cardiovascular Medicine, Faculty of Life Science, Graduate School of Medical Sciences,
Kumamoto University, Kumamoto 860-8556, Japan; tsujita@kumamoto-u.ac.jp
4 Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine,
Tokyo 105-0003, Japan; m.yoshimura@jikei.ac.jp
* Correspondence: aldh2@icloud.com; Tel.: +81-96-248-3355
Abstract: Heart 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 phosphate retention is a trigger for arterial stiffness. This study focuses on whether
arterial stiffness due to phosphate retention could be a predictor for HFpEF. Methods: The subjects
of this study were 158 patients (68 males and 90 females, mean age 74.8 ± 11.2). HFpEF was
defined according to the guidelines of the ESC 2019. Pulse wave velocity (PWV) and central systolic
blood pressure (CSBP) were used as markers for arterial stiffness and afterload, respectively. We
measured serum levels of fibroblast growth factor 23 (FGF23) as a marker of phosphate retention.
Results: The serum levels of FGF23 had a significant relationship with PWV. PWV had significant
relationships with LV mass index, plasma BNP levels, and relative wall thickness, e′ , and E/e′
(p < 0.001, respectively). Multivariate logistic regression analysis revealed that higher PWV values
and hypertension were significant predictors for the dependent factor (HFpEF). Arterial stiffness
amplified afterload, leading to LV concentric hypertrophy and diastolic dysfunction. This study
presents that arterial stiffness is a key predictor of HFpEF, and that phosphate retention is involved
in the pathology of HFpEF.
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