FIBFAR: Hemodynamic-Inflammatory phenotype associated with subclinical carotid atherosclerosis in patients with cardiometabolic risk

pp. 368-377

Abstract

Background: Systemic inflammation and hemodynamic alterations  represent complementary pathophysiological mechanisms involved in cardiovascular disease. The identification of integrative phenotypes using noninvasive tools could contribute to better characterization of subclinical atherosclerosis.

Objective: To evaluate the association between the low flow, high-systemic vascular resistance hemodynamic-inflammatory phenotype (FIBFAR) and the presence of carotid plaque in patients with cardiometabolic risk, defined by the presence of hypertension and diabetes or prediabetes.

Methods: An observational, analytical, cross-sectional study based on a retrospective analysis of 243 outpatients aged ≥18 years with hypertension and diabetes mellitus or prediabetes. Clinical, biochemical, and hemodynamic variables were analyzed, including high-sensitivity C-reactive protein (hs-CRP), cardiac index (CI),  and systemic vascular resistance (SVR) measured by impedance cardiography. Carotid plaque was assessed using Doppler ultrasound. The association between FIBFAR (hs-CRP ≥2.5 mg/L, CI <2.5 L/min/m², and SVR >1600 dynes·s·cm-5) and carotid plaque was assessed using multivariate logistic regression.

Results: The median age was 58 years (IQR 49-67), and 64.0% were male. The prevalence of carotid plaque was 37.0%. The FIBFAR phenotype was present in 23.0% of the cohort and was independently associated with carotid plaque (OR 8.60; 95% CI: 4.39-17.70; p < 0.001), along with age ≥65 years (OR 1.94; 95% CI: 1.01-3.72; p = 0.047). The model showed appropriate calibration (Hosmer-Lemeshow p = 0.374) and moderate discriminatory power (AUC = 0.73; 95% CI: 0.66-0.79; p < 0.001).

Conclusions: In patients with cardiometabolic risk, the FIBFAR phenotype was independently associated with subclinical carotid atherosclerosis. Given the cross-sectional design, these findings should be interpreted as statistical associations and require prospective validation before their clinical application can be considered.