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Pulse pressure/stroke index and left ventricular geometry and function: the LIFE Study
Vittorio Palmieri1, Jonathan N Bella, Mary J Roman
1Weill Medical College of Cornell University, New York, NY 10021, USA. vpalmier@med.cornell.edu
Insights
Increased arterial stiffness, measured by pulse pressure/stroke index ratio (PP/SVi), is linked to specific left ventricular geometry and diastolic dysfunction in hypertensive patients.
Area of Science:
- Cardiology
- Hypertension Research
- Vascular Physiology
Background:
- Arterial stiffness is a key indicator of cardiovascular risk.
- Left ventricular (LV) geometry and function are crucial in hypertension management.
- The relationship between arterial stiffness and LV abnormalities requires further elucidation.
Purpose of the Study:
- To investigate the association between arterial stiffness, estimated by the pulse pressure/stroke index ratio (PP/SVi), and left ventricular (LV) geometry and function.
- To identify specific LV abnormalities linked to increased arterial stiffness in hypertensive individuals.
Main Methods:
- Utilized baseline data from the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study echocardiographic substudy.
- Included patients with stage II-III hypertension and electrocardiographic LV hypertrophy, excluding those with coronary heart disease or wall motion abnormalities.
- Assessed plasma glucose, lipids, creatinine, and urinary albumin/creatinine using standard methods; analyzed PP/SVi in relation to LV parameters.
Main Results:
- Higher PP/SVi correlated with increased age, female proportion, type 2 diabetes, and systolic/mean blood pressures, but lower BMI and height.
- Increased PP/SVi was associated with concentric LV geometry and higher LV end-systolic stress.
- Stress-corrected LV chamber function, mitral E/A ratio, and shorter isovolumic relaxation time were greater with higher PP/SVi, independent of confounders.
Conclusions:
- Elevated arterial stiffness, indicated by PP/SVi, is associated with concentric left ventricular geometry.
- Increased arterial stiffness is linked to diastolic abnormalities, suggesting increased diastolic stiffness of the left ventricle.
Objective:
To evaluate the relationship between arterial stiffness estimated by the pulse pressure/stroke index ratio (PP/SVi) and prognostically relevant abnormalities of left ventricular geometry and function.
Methods:
Baseline data from the echocardiographic substudy of the Losartan Intervention For Endpoint (LIFE) Reduction in Hypertension Study were used. Patients involved in the present study had stage II-III hypertension and electrocardiographic left ventricular hypertrophy; those with a history of coronary heart disease or segmental wall motion abnormalities were excluded. Plasma glucose, total and high-density lipoprotein (HDL) cholesterol and creatinine concentrations and urinary albumin/creatinine were assessed by standard methods.
Results:
The study sample (n = 667) was subdivided into tertiles of PP/SVi. With greater PP/SVi, age, proportion of women and prevalence of type 2 diabetes, systolic and mean blood pressures were greater, whereas body mass index, body height and diastolic blood pressure were lower. Total and HDL cholesterol, creatinine and albuminuria did not differ among the three groups. After adjustment for age, sex and body size, greater PP/SVi was related to concentric left ventricular geometry, but showed a weak negative relationship to left ventricular mass and aortic root diameter; the prevalence of aortic fibrocalcification and left atrial diameter did not differ among tertiles of PP/SVi. PP/SVi was related to greater left ventricular end-systolic stress; stress-corrected left ventricular chamber function was greater with greater PP/SVi, whereas myocardial contractility did not differ significantly among the three groups. Greater PP/SVi was related to greater mitral E-wave/A-wave ratio and shorter isovolumic relaxation time independently of age, sex, left ventricular geometry, systolic function and other confounders.
Conclusion:
Increased estimated arterial stiffness is associated with concentric left ventricular geometry and with diastolic left ventricular abnormalities suggestive of increased diastolic left ventricular stiffness.
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