Resistive and pulsatile arterial load as predictors of left ventricular mass and geometry: the multi-ethnic study of atherosclerosis
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Published on: August 30, 2022
Payman Zamani1, David A Bluemke2, David R Jacobs2
1From the Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Perelman School of Medicine and Philadelphia VA Medical Center (P.Z., V.A.F., J.A.C.); National Institute of Biomedical Imaging and Bioengineering, National Institutes of Health, Bethesda, MD (D.A.B.); Departments of Radiology and Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (D.A.B.); Division of Epidemiology and Community Health (D.R.J., P.H.) and Division of Cardiology (D.A.D.), School of Medicine, University of Minnesota, Minneapolis; Department of Biostatistics, School of Public Health, University of Washington, Seattle (R.K.); Division of Cardiovascular Medicine, The Ohio State University Heart and Vascular Center, Columbus (S.M.L.); Division of Nephrology/Hypertension, Perelman School of Medicine, University of Pennsylvania, Philadelphia (R.R.T.); Division of Cardiology, Johns Hopkins Hospital, Baltimore, MD (J.A.L.); Los Angeles Biomedical Research Institute, Torrance, CA (M.B.); and Biofluid, Tissue, and Solid Mechanics for Medical Applications, IBiTech, iMinds Medical IT, Ghent University, Ghent, Belgium (P.S.). pzamani@upenn.edu.
Insights
Arterial load components, including systemic vascular resistance and pulsatile load, significantly influence left ventricular remodeling. Women experience greater pulsatile load than men, impacting cardiac structure.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Clinical Cardiology
Background:
- Arterial load comprises resistive and pulsatile elements, but their distinct roles in left ventricular (LV) remodeling are not fully understood in the general population.
- Left ventricular remodeling is a critical process influencing cardiac function and disease progression.
Purpose of the Study:
- To investigate the independent contributions of resistive (systemic vascular resistance) and pulsatile (total arterial compliance, forward, and reflected wave amplitudes) arterial load components to left ventricular mass and remodeling.
- To compare arterial load characteristics between men and women.
Main Methods:
- Utilized data from 4145 participants in the Multi-Ethnic Study of Atherosclerosis, employing cardiac MRI and radial arterial tonometry.
- Calculated systemic vascular resistance (SVR) and pulsatile load indices (total arterial compliance [TAC], forward wave amplitude [Pf], reflected wave amplitude [Pb]).
- Performed multivariable regression analyses to assess associations with LV mass and LV wall/LV cavity volume ratio, adjusting for confounders and standardizing for body size and sex.
Main Results:
- Systemic vascular resistance (SVR), total arterial compliance (TAC), reflected wave amplitude (Pb), and forward wave amplitude (Pf) were significant independent predictors of LV mass.
- TAC, SVR, and Pf were independently associated with the LV wall/LV cavity volume ratio, indicating effects on concentric remodeling.
- Women exhibited a greater pulsatile load, characterized by lower indexed TAC and higher indexed SVR compared to men.
Conclusions:
- Different components of arterial load differentially impact left ventricular hypertrophy and concentric remodeling.
- The sequence of arterial loading (early vs. late load) is a key determinant of the left ventricular response to arterial load.
- Findings highlight sex-based differences in arterial load and its implications for cardiac remodeling.
Abstract:
Arterial load is composed of resistive and various pulsatile components, but their relative contributions to left ventricular (LV) remodeling in the general population are unknown. We studied 4145 participants enrolled in the Multi-Ethnic Study of Atherosclerosis, who underwent cardiac MRI and radial arterial tonometry. We computed systemic vascular resistance (SVR=mean arterial pressure/cardiac output) and indices of pulsatile load including total arterial compliance (TAC, approximated as stroke volume/central pulse pressure), forward wave amplitude (Pf), and reflected wave amplitude (Pb). TAC and SVR were adjusted for body surface area to allow for appropriate sex comparisons. We performed allometric adjustment of LV mass for body size and sex and computed standardized regression coefficients (β) for each measure of arterial load. In multivariable regression models that adjusted for multiple confounders, SVR (β=0.08; P<0.001), TAC (β=0.44; P<0.001), Pb (β=0.73; P<0.001), and Pf (β=-0.23; P=0.001) were significant independent predictors of LV mass. Conversely, TAC (β=-0.43; P<0.001), SVR (β=0.22; P<0.001), and Pf (β=-0.18; P=0.004) were independently associated with the LV wall/LV cavity volume ratio. Women demonstrated greater pulsatile load than men, as evidenced by a lower indexed TAC (0.89 versus 1.04 mL/mm Hg per square meter; P<0.0001), whereas men demonstrated a higher indexed SVR (34.0 versus 32.8 Wood Units×m2; P<0.0001). In conclusion, various components of arterial load differentially associate with LV hypertrophy and concentric remodeling. Women demonstrated greater pulsatile load than men. For both LV mass and the LV wall/LV cavity volume ratio, the loading sequence (ie, early load versus late load) is an important determinant of LV response to arterial load.
