Correlation of pulse wave velocity with left ventricular mass in patients with hypertension once blood pressure has
1Department of Medicine, University of British Columbia, Vancouver, B.C., Canada.
Insights
Vascular stiffness, measured by pulse wave velocity (PWV), correlates with left ventricular hypertrophy (LVH) in hypertensive patients. PWV is a better indicator of LVH than augmentation index (AI) even with controlled blood pressure.
Area of Science:
- Cardiovascular Physiology
- Hypertension Research
- Echocardiography
Background:
- Vascular stiffness is a proposed indicator of arterial loading conditions contributing to left ventricular hypertrophy (LVH).
- Controversy exists regarding the independence of vascular stiffness-LVH relationship from blood pressure (BP) and the superiority of augmentation index (AI) versus pulse wave velocity (PWV) measurements.
- Hypertension is a major risk factor for cardiovascular complications, including LVH.
Purpose of the Study:
- To investigate the relationship between vascular stiffness and left ventricular mass in hypertensive patients with controlled BP.
- To compare the efficacy of pulse wave velocity (PWV) and augmentation index (AI) as markers for left ventricular hypertrophy (LVH).
- To determine if vascular stiffness is an independent predictor of LVH in treated hypertensive individuals.
Main Methods:
- Measurement of carotid pulse wave contour and pulse wave velocity (PWV) in 20 hypertensive patients with BP <140/90 mmHg and no valvular heart disease.
- Calculation of left ventricular mass from 2D echocardiograms, adjusted for body surface area and height.
- Comparison of correlation between LV mass index and PWV versus AI.
Main Results:
- A significant linear correlation (P<0.05) was found between left ventricular (LV) mass index and pulse wave velocity (PWV).
- This correlation was independent of blood pressure (BP) levels and not influenced by gender.
- In contrast to PWV, no significant correlation was observed between LV mass and augmentation index (AI).
Conclusions:
- Aortic vascular stiffness, specifically PWV, is a significant indicator of LV mass in hypertensive patients, even when BP is controlled.
- PWV is a superior surrogate marker for LV mass compared to AI in this patient population.
- PWV measurement offers a potentially rapid and cost-effective method for assessing LVH in hypertensive patients.
Abstract:
Vascular stiffness has been proposed as a simple method to assess arterial loading conditions of the heart which induce left ventricular hypertrophy (LVH). There is some controversy as to whether the relationship of vascular stiffness to LVH is independent of blood pressure, and which measurement of arterial stiffness, augmentation index (AI) or pulse wave velocity (PWV) is best. Carotid pulse wave contor and pulse wave velocity of patients (n=20) with hypertension whose blood pressure (BP) was under control (<140/90 mmHg) with antihypertensive drug treatment medications, and without valvular heart disease, were measured. Left ventricular mass, calculated from 2D echocardiogram, was adjusted for body size using two different methods: body surface area and height. There was a significant (P<0.05) linear correlation between LV mass index and pulse wave velocity. This was not explained by BP level or lower LV mass in women, as there was no significant difference in PWV according to gender (1140.1+67.8 vs 1110.6+57.7 cm/s). In contrast to PWV, there was no significant correlation between LV mass and AI. In summary, these data suggest that aortic vascular stiffness is an indicator of LV mass even when blood pressure is controlled to less than 140/90 mmHg in hypertensive patients. The data further suggest that PWV is a better proxy or surrogate marker for LV mass than AI and the measurement of PWV may be useful as a rapid and less expensive assessment of the presence of LVH in this patient population.
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