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Updated: Apr 15, 2026
Transthoracic Speckle Tracking Echocardiography for the Quantitative Assessment of Left Ventricular Myocardial Deformation
Published on: October 20, 2016
Associations of Alterations in Pulsatile Arterial Load With Left Ventricular Longitudinal Strain
Zi Ye1, Thais Coutinho1, Patricia A Pellikka1
1Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Increased arterial stiffness, measured by characteristic aortic impedance (Zc), is linked to reduced left ventricular (LV) systolic function (global longitudinal strain). This finding highlights Zc as a key indicator of cardiac health in adults.
Area of Science:
- Cardiology
- Vascular Physiology
- Echocardiography
Background:
- Increased arterial stiffness elevates the heart's pulsatile load.
- Arterial stiffness is a risk factor for cardiovascular disease.
Purpose of the Study:
- To investigate the association between pulsatile load components and left ventricular (LV) systolic function, specifically global longitudinal strain (GLS).
- To assess these associations in a community-based cohort with a family history of hypertension.
Main Methods:
- 520 adults with normal LV ejection fraction underwent arterial tonometry and echocardiography with speckle tracking.
- Measures of pulsatile load (characteristic aortic impedance (Zc), total arterial compliance (TAC), augmentation index (AI)) and GLS were quantified.
- Sex-specific z-scores were used to assess associations of log-Zc, log-TAC, and AI with GLS.
Main Results:
- Univariable analysis showed higher Zc correlated with worse GLS, while higher TAC and AI correlated with better GLS.
- In multivariable models, only Zc remained significantly associated with GLS (β = 0.28, P < 0.001) after adjusting for age, sex, heart rate, LVEF, and mean arterial load.
- This association persisted after further adjustment for cardiovascular risk factors and history of cardiovascular events.
Conclusions:
- Higher characteristic aortic impedance (Zc), reflecting proximal aortic stiffness, is independently associated with impaired LV longitudinal function.
- Zc is a significant predictor of GLS, independent of other cardiovascular risk factors.
Background:
Increased arterial stiffness leads to increased pulsatile load on the heart. We investigated associations of components of pulsatile load with a measure of left ventricular (LV) systolic function-global longitudinal strain (GLS), in a community-based cohort ascertained based on family history of hypertension.
Methods:
Arterial tonometry and echocardiography with speckle tracking were performed in 520 adults with normal LV ejection fraction (EF) (age 67±9 years, 70% hypertensive) to quantify measures of pulsatile load (characteristic aortic impedance (Zc), total arterial compliance (TAC), and augmentation index (AI)) and GLS. The associations of log-Zc, log-TAC, and AI with GLS were assessed using sex-specific z-scores for each measure of arterial load.
Results:
In univariable analyses, higher Zc was associated with worse GLS (less negative) and higher TAC and AI were associated with better GLS (all P < 0.001). In a multivariable model including age, sex, heart rate (HR), LVEF, mean arterial load (systemic vascular resistance), and measures of pulsatile load, Zc remained associated with GLS (β = 0.28, P < 0.001), while the associations of TAC and AI were no longer significant (P > 0.5). Additional adjustment for cardiovascular risk factors and history of coronary heart disease and stroke did not attenuate the association of Zc with GLS; Zc, sex, HR, LVEF remained associated with GLS after stepwise elimination (all P < 0.001).
Conclusions:
Greater proximal aortic stiffness, as manifested by a higher Zc, is independently associated with worse LV longitudinal function.
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