In a community-based Swedish cohort of 991 adults (mean age 51), non-invasive radial artery applanation tonometry revealed that small-artery elasticity (C2) independently predicted higher left ventricular ejection fraction (β = 1.2% per 1-SD increase; 95% CI: 0.5–1.9), while large-artery elasticity (C1) was associated with 39% lower odds of left ventricular hypertrophy (OR 0.61; 95% CI: 0.44–0.84), even after adjusting for systolic blood pressure, diabetes, LDL, BMI, and lifestyle factors.
This finding matters because it separates the vascular contributions of large- and small-artery compliance to distinct cardiac remodeling pathways — LVH versus systolic dysfunction — a mechanistic distinction that blood pressure measurement alone cannot capture. Arterial stiffness research has long focused on large-artery metrics like pulse wave velocity, making C2's independent link to ejection fraction a noteworthy addition. Clinically, if validated, pulse wave analysis could flag subclinical ventriculo-arterial mismatch before overt heart failure develops, enabling earlier intervention. Important limitations apply: this is a cross-sectional design precluding causal inference, the cohort was recruited between 2002 and 2005 from a single Swedish region limiting generalizability, and echocardiography was performed on only a subsample. As a preprint posted to medRxiv and not yet peer-reviewed, these results should be interpreted cautiously — findings and effect sizes may shift after independent scrutiny. Overall, this is confirmatory-to-incremental work that strengthens the physiological rationale for vascular phenotyping beyond blood pressure.
