Estimated pulse wave velocity and risk of new-onset heart failure in ICU patients with acute myocardial infarction: a multicenter cohort study

Abstract

Background To investigate the association between estimated pulse wave velocity (ePWV) and new-onset heart failure (HF) in ICU patients with acute myocardial infarction (AMI), and to evaluate its incremental predictive value. Methods ICU patients with AMI were identified from the eICU-CRD cohort, and an independent real-world ICU cohort was used for external validation. New-onset HF was the primary outcome. Multivariable regression models were used to assess the association between ePWV and new-onset HF across different time periods. Restricted cubic spline analysis was performed to evaluate the dose-response relationship, and incremental value analysis was conducted to determine the added predictive value of ePWV beyond traditional risk models. Results In the eICU-CRD cohort, the incidence of new-onset HF was 10.2%. After full adjustment, each 1-unit increase in ePWV was associated with a 13% higher risk of in-hospital heart failure (HR = 1.13, 95% CI: 1.09–1.18, P < 0.001), and the high-ePWV group had a significantly increased risk (HR = 1.84, 95% CI: 1.50–2.24, P < 0.001). In the validation cohort, the incidence of heart failure was 12.9%; each 1-unit increase in ePWV was associated with a 16% higher risk (OR = 1.16, 95% CI: 1.01–1.35, P = 0.046), and the high-ePWV group also showed increased risk (OR = 2.21, 95% CI: 1.02–4.78, P = 0.044). ePWV showed a nonlinear positive association with heart failure risk, and significantly improved model discrimination. Conclusions Higher ePWV was independently and nonlinearly associated with in-hospital new-onset HF among ICU patients with AMI and improved risk discrimination beyond conventional clinical models. Its association with 1-year post-discharge HF in this high-risk population showed a consistent direction but requires further validation in larger prospective cohorts.