The clinical usefulness of central hemodynamics to evaluate diastolic dysfunction in subjects without hypertension
Geehee Kim1, Ji-Hoon Kim1, Keon-Woong Moon1
1Division of Cardiology, Department of Internal Medicine, St Vincent's Hospital, Catholic University of Korea, Suwon, South Korea.
Insights
Arterial stiffness, measured by ΔBP and radial augmentation index (RaAIx), is linked to diastolic dysfunction in individuals without hypertension. These noninvasive measures may help identify diastolic dysfunction even with normal blood pressure.
Area of Science:
- Cardiology
- Vascular Physiology
- Diagnostic Imaging
Background:
- Diastolic dysfunction is a known complication of hypertension, often linked to increased arterial stiffness.
- The relationship between arterial stiffness and diastolic dysfunction in non-hypertensive individuals remains less understood.
Purpose of the Study:
- To investigate the association between arterial stiffness and diastolic dysfunction in subjects without hypertension.
- To determine if noninvasive measures of arterial stiffness can predict diastolic dysfunction in this population.
Main Methods:
- A cohort of 287 subjects without hypertension or heart disease underwent transthoracic echocardiography and noninvasive radial artery applanation tonometry.
- Key parameters of arterial stiffness, including ΔBP and radial augmentation index (RaAIx), were assessed.
Main Results:
- Diastolic dysfunction was identified in 51.2% of the subjects.
- Both ΔBP and increased RaAIx were significantly associated with diastolic dysfunction.
- Receiver operating-characteristic curve analysis demonstrated the predictive value of ΔBP and RaAIx for diastolic dysfunction.
Conclusions:
- Increased arterial stiffness, indicated by ΔBP and RaAIx, is associated with diastolic dysfunction in individuals with normal peripheral blood pressure.
- Noninvasive estimation of central blood pressure may serve as a valuable tool for detecting diastolic dysfunction in this demographic.
Objective:
Diastolic dysfunction is associated with increased arterial stiffness in patients with hypertension. However, the role of arterial stiffness in diastolic dysfunction in subjects without hypertension has not been fully established.
Materials And Methods:
A total of 287 subjects (male:female ratio 121:166, mean age 53.0±14.4 years) without hypertension or any heart disease who simultaneously received transthoracic echocardiography and noninvasively semiautomated radial artery applanation tonometry (with an Omron HEM-9000AI) in the Department of Internal Medicine, St Vincent's Hospital, from July 2011 to September 2012, were enrolled in this study.
Results:
A total of 147 subjects (male:female ratio 59:88, mean age 61.7±9.9 years), representing 51.2% of the 287 subjects, had diastolic dysfunction (defined as abnormal relaxation pattern of mitral inflow). There were significant differences in systolic blood pressure (BP), pulse pressure, late systolic peak pressure (SBP2), and radial augmentation index (RaAIx) between normal diastolic function and diastolic dysfunction. ΔBP was defined as systolic BP minus SBP2, because of the difference in systolic BP between the two groups. ΔBP (odds ratio [OR] 1.059, 95% confidence interval [CI] 1.005-1.115; P=0.032) and RaAIx (odds ratio 1.027, 95% CI 1.009-1.044, P=0.003) were associated with diastolic dysfunction. A receiver operating-characteristic curve showed that ΔBP (area under the curve 0.875, 95% CI 0.832-0.911) and RaAIx (area under the curve 0.878, 95% CI 0.835-0.914) were associated with diastolic dysfunction.
Conclusion:
We found that ΔBP and increased RaAIx were associated with diastolic dysfunction in subjects without hypertension after adjustment for age and sex. Therefore, it is suggested that noninvasive estimation of central BP may be useful to reflect diastolic dysfunction in subjects with normal peripheral BP.
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