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Arterial properties as determinants of time-varying myocardial stress in humans
Julio A Chirinos1, Patrick Segers, Thierry C Gillebert
1Philadelphia Veterans Affairs Medical Center/University of Pennsylvania, Philadelphia, PA, USA. julio.chirinos@uphs.upenn.edu
Insights
Arterial properties significantly influence myocardial wall stress over time. Women exhibit less efficient heart-artery communication, leading to higher wall stress and potential heart failure susceptibility.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Clinical Cardiology
Background:
- Myocardial and arterial load are dynamic processes crucial for heart function.
- Understanding the arterial determinants of time-resolved myocardial wall stress is essential but currently limited.
Purpose of the Study:
- To investigate how specific arterial properties impact time-varying myocardial wall stress.
- To compare these effects between men and women in a large cohort.
Main Methods:
- Utilized data from 1214 participants in the Asklepios Study.
- Measured time-resolved central pressure, flow, and left ventricular geometry using carotid tonometry, Doppler, and echocardiography.
- Computed arterial load and ejection-phase time-varying myocardial wall stress.
Main Results:
- Peak myocardial stress correlated with systemic vascular resistance and aortic characteristic impedance.
- Ejection-phase stress-time integral was associated with systemic vascular resistance, arterial compliance, and wave reflection timing.
- End-systolic wall stress related to systemic vascular resistance and reflection magnitude.
- Women showed significantly higher peak, end-systolic, and ejection-phase stress-time integral compared to men, independent of other factors.
Conclusions:
- Distinct arterial properties selectively affect different aspects of myocardial wall stress, highlighting the limitations of single-time point assessments.
- Women exhibit less efficient myocardial-arterial coupling, characterized by elevated wall stress for given cardiac conditions.
- These findings may explain the increased susceptibility of women to heart failure.
Abstract:
Myocardial and arterial load are time-varying phenomena. Despite their importance in myocardial function, the arterial properties that determine time-resolved myocardial wall stress are unknown. We aimed to assess arterial properties as determinants of time-resolved myocardial stress among 1214 men and women enrolled in the Asklepios Study. Time-resolved central pressure, flow, and left ventricular geometry were measured with carotid tonometry, Doppler, and speckle-tracking echocardiography, respectively, for computation of arterial load and ejection-phase time-varying myocardial wall stress. For any given end-diastolic left ventricular geometry and cardiac output, peak myocardial stress correlated directly with systemic vascular resistance (standardized β=1.12; P<0.0001) and aortic characteristic impedance (standardized β=0.17; P<0.0001). The ejection-phase stress-time integral correlated with systemic vascular resistance (standardized β=1.06; P<0.0001), lower total arterial compliance (standardized β=-0.13; P=0.0008), and earlier return of wave reflections (standardized β=-0.10; P<0.0001) but not with reflection magnitude, whereas end-systolic wall stress correlated with systemic vascular resistance (standardized β=1.06; P<0.0001) and reflection magnitude (standardized β=0.12; P<0.0001). After adjustment for age, all of the measured arterial properties, end-diastolic left ventricular geometry, and cardiac output, women demonstrated greater peak (534 versus 507 kdyne/cm(2); P<0.0001), end-systolic (335 versus 320 kdyne/cm(2); P<0.0001), and ejection-phase stress-time integral (157 versus 142 kdyne · s · cm(-2); P<0.0001). In conclusion, different arterial properties have selective effects on time-resolved ejection-phase myocardial wall stress, which are not apparent from single-time point measurements. Women demonstrate less efficient myocardial-arterial coupling, with higher wall stress development for any given left ventricular geometry, arterial properties, and flow output. These observations may relate to the differential susceptibility of women to heart failure.
