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Relation of hemodynamics and risk factors to ventricular-vascular interactions in the elderly: the Cardiovascular
G de Simone1, R McClelland, J S Gottdiener
1Department of Clinical and Experimental Medicine, Federico II University Hospital, Naples, Italy. simogi@unina.it
Insights
Left ventricular geometry influences carotid artery structure and arterial stiffness, particularly in individuals with normal blood pressure. Cardiovascular risk factors modify this relationship in hypertensive patients.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Cardiac Imaging
Background:
- Left ventricular (LV) geometry and carotid artery structure are key indicators of cardiovascular health.
- Arterial compliance reflects the elasticity of blood vessels and is crucial for hemodynamic stability.
- Understanding the interplay between cardiac structure, vascular characteristics, and hemodynamic factors is essential for assessing cardiovascular risk.
Purpose of the Study:
- To investigate the relationship between left ventricular (LV) geometry, carotid artery structure, and arterial compliance.
- To examine how hemodynamic stimuli and cardiovascular risk factors influence these interactions.
- To explore the impact of factors like cholesterol, BMI, insulin resistance, smoking, age, sex, and race on cardiovascular parameters.
Main Methods:
- A cross-sectional study involving 2375 elderly subjects from the Cardiovascular Health Study cohort.
- Echocardiography and carotid ultrasound were used to assess LV geometry and carotid structure.
- Arterial compliance was estimated using the stroke volume to pulse pressure (SV/PP) ratio, adjusted for age, heart rate, and body weight.
Main Results:
- Intima-medial thickness (IMT) and carotid lumen diameter (CLD) were associated with LV hypertrophy (LVH), with variations based on LVH geometry (concentric vs. eccentric).
- CLD correlated positively with stroke volume, and IMT with LV mass, independent of blood pressure.
- Arterial stiffness (SV/PP-Delta%) was reduced in concentric LV remodeling and LVH. The relationship between IMT and arterial stiffness was significant in normotensive individuals but not in hypertensives after adjusting for risk factors.
Conclusions:
- Carotid intima-medial thickness and lumen diameter dimensions are linked to LV mass and geometry.
- These carotid parameters are directly related to stroke volume and arterial stiffness.
- The interaction between LV geometry, carotid structure, and arterial stiffness is most pronounced in normotensive individuals and is modulated by cardiovascular risk factors in the presence of hypertension.
Objective:
To investigate the interaction between left ventricular (LV) geometry, carotid structure and arterial compliance in relation to hemodynamic stimuli and risk factors (plasma cholesterol, body mass index, insulin resistance, smoking habit, age, sex and race).
Design:
Cross-sectional.
Methods:
Echocardiography and carotid ultrasound were performed in 2375 elderly subjects without signs or history of prevalent cardiovascular disease, diabetes or renal disease (795 men; 298 non-whites; 1215 hypertensive), from the cohort of the Cardiovascular Health Study. Arterial compliance was estimated by the prognostically validated ratio of stroke volume to pulse pressure (SV/PP) as the percent deviation (Delta%) from the value predicted by individual age, heart rate and body weight.
Results:
Intima-medial thickness (IMT) was higher in the presence of LV hypertrophy (LVH) in normotensive and hypertensive subjects and was greatest in the presence of concentric LVH. Maximum carotid lumen diameter (CLD) was also higher in the presence of LVH (and was greatest with eccentric LVH, in association with relatively high values for stroke volume). After adjusting for blood pressure, maximum carotid lumen diameter was directly correlated with stroke volume, and IMT to LV mass (all P < 0.001). Similarly, IMT was also related to maximum carotid lumen diameter, independently of prevalent risk factors (P < 0.001). SV/PP-Delta% was reduced in both groups with concentric LV remodeling (both P < 0.0001) or concentric LVH (both P < 0.05). Adjusting for risk factors did not affect these associations in normotensives, but made them insignificant in hypertensives. In normotensives, IMT was inversely related to SV/PP-Delta% (P < 0.001), independently of risk factors, whereas no significant relation was found in hypertensives.
Conclusions:
The magnitudes of carotid intima-medial thickness and lumen diameter parallel levels of LV mass and geometry, and are directly related to stroke volume and arterial stiffness; this interaction is most evident in the presence of normal blood pressure, whereas it is affected by other cardiovascular risk factors when arterial hypertension is present.
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