The relationship of carotid arterial stiffness to left ventricular diastolic dysfunction in untreated hypertension

Interest in the role of arterial stiffness in the pathomechanism of left ventricular (LV) diastolic dysfunction has grown in recent years.

To examine the relationship between local carotid arterial stiffness parameters assessed by the ultrasonic high-resolution echo-tracking (eT) method and LV diastolic function indices in patients with untreated hypertension (H).

The study group consisted of 173 subjects, 78 male and 95 female, 113 of them with untreated H, mean age 55.7 ± 10.4 years, and 60 age-matched controls. Using 2D echo, conventional and tissue Doppler echocardiography, LV systolic and diastolic function and left ventricular hypertrophy (LVH) indices were assessed. Hypertensives were divided into two groups: those with diastolic dysfunction (HDD+: with relaxation abnormalities, n = 55 and with pseudonormalisation pattern, n = 12); and those without diastolic dysfunction (HDD-, n = 46). Using carotid arteries ultrasound, intima media thickness (IMT) and eT arterial stiffness parameters were evaluated, as also were β - beta, Ep - epsilon, AC - arterial compliance, PWVβ - one-point pulse wave velocity and AI - augmentation index.

Linear regression analysis revealed significant correlations between arterial stiffness indices and diastolic function parameters in the study groups: the ratio of early to late transmitral pulse Doppler velocities - E/A - correlated to Ep,β, AC and PWVβ (r = -0.30, r = -0.25, r = 0.26, r = -0.30, respectively, p < 0.05); early diastolic mitral annular velocity - e' - correlated to Ep, β and PWVβ (r = -0.22, r = -0.26, r = -0.25, respectively, p < 0.05); the ratio of early to late diastolic mitral annular velocities - e'/a' - was correlated with β and PWVβ (r = -0.28, r = -0.28, respectively, p < 0.05). HDD+ did not present echocardiographic LVH. Using ROC curve analysis, we identified optimal cut-off values of different parameters in the determination of diastolic dysfunction occurrence. Univariable analysis revealed the following significant variables in determining LV diastolic dysfunction: β > 9.2 (OR 2.65, p = 0.026), Ep > 118 kPa (OR 3.53, p = 0.040), PWVβ > 6.2 m/s (OR 3.92, p = 0.002), AI > 7.8 (OR 2.62, p = 0.049), age > 54 (OR 4.76, p < 0.001), diabetes presence (OR 2.78, p = 0.013), IMT > 0.51 mm (OR 4.49, p < 0.001), diastolic blood pressure < 70 mm Hg (OR 3.38, p = 0.047), pulse pressure > 64 (OR 2,90, p = 0.031) and ejection fraction < 76 (OR 3.38, p = 0.019). However, at multivariate analysis, only age (OR = 2.43, p = 0.073), IMT (OR = 4.56, p = 0.002) and PWVβ (OR = 2.18; p = 0.091) were independently associated with diastolic dysfunction occurrence.

Carotid IMT as a marker of subclinical atherosclerosis and PWVβ as an index of carotid arterial stiffness are, besides age, independently associated with LV early diastolic dysfunction occurrence in untreated middle-aged hypertensives.