Arterial wave reflections and ventricular-vascular interaction in patients with left ventricular systolic dysfunction

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Antonella Paglia1, Laura Sasso, Flora Pirozzi

  • 1Department of Translational Medical Sciences- Section of Internal Medicine, University of Naples Federico II.

International Heart Journal
|October 17, 2014
PubMed

Insights

In chronic heart failure, severe left ventricular systolic dysfunction (LVSD) alters aortic pressure waveforms by increasing wave reflections, negatively impacting heart function. Moderate LVSD shows similar waveforms to healthy individuals.

Area of Science:

  • Cardiovascular Physiology
  • Hemodynamics
  • Heart Failure Research

Background:

  • Central aortic pressure waveform (AoPW) results from left ventricular (LV) ejection and wave reflections.
  • Ventricular-vascular coupling significantly influences cardiovascular dynamics.
  • Left ventricular systolic dysfunction (LVSD) alters cardiac output and vascular impedance.

Purpose of the Study:

  • To investigate the impact of varying degrees of LVSD on AoPW morphology.
  • To assess the role of ventricular-vascular coupling in shaping AoPW in heart failure patients.
  • To utilize pulse wave analysis (PWA) for evaluating AoPW and LV function.

Main Methods:

  • Applanation tonometry was used to measure AoPW and LV function.
  • Study included 26 controls, 14 patients with LVEF > 30% (moderate LVSD), and 12 patients with LVEF ≤ 30% (severe LVSD).
  • Pulse wave analysis (PWA) parameters were analyzed and correlated with Doppler echocardiographic measures.

Main Results:

  • Patients with severe LVSD (LVEF ≤ 30%) exhibited lower augmentation pressure, augmentation index, wasted energy, and ejection duration compared to moderate LVSD and controls.
  • Augmentation index inversely correlated with mitral E-wave amplitude and E/A ratio, and directly with E-wave deceleration time.
  • Severe LVSD was associated with negative interference of aortic wave reflections on LV function and shortened ejection duration.

Conclusions:

  • In severe LVSD, aortic wave reflections detrimentally affect LV function, shortening ejection duration.
  • AoPW morphology in moderate LVSD patients resembles that of control subjects.
  • Ventricular-vascular coupling plays a crucial role in modulating AoPW in heart failure.

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