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Doppler indexes of left ventricular systolic and diastolic function in relation to the arterial stiffness in a
Nicholas Cauwenberghs1, Judita Knez, Valérie Tikhonoff
1aDepartment of Cardiovascular Sciences, The Studies Coordinating Centre, Research Unit Hypertension and Cardiovascular Epidemiology, University of Leuven, Leuven, Belgium bThe Department of Clinical and Experimental Medicine, University of Padova, Padova, Italy cDepartment of Cardiovascular Sciences, Division of Cardiovascular Imaging and Dynamics, University of Leuven, Leuven, Belgium dThe First Department of Cardiology and Hypertension, Jagiellonian University Medical College, Kraków, Poland eStanford Cardiovascular Institute, Stanford, California, USA fDepartment of Hypertension and Diabetology, Hypertension Unit, Medical University of Gdansk, Gdansk, Poland.
Insights
Arterial stiffness significantly impacts left ventricular (LV) function, affecting both systolic and diastolic performance. This study reveals age-dependent changes in how arterial stiffness relates to LV strain, highlighting its role in cardiovascular health.
Area of Science:
- Cardiovascular Physiology
- Echocardiography
- Vascular Biology
Background:
- Late-systolic left ventricular (LV) loading is influenced by arterial wave reflections and central vascular stiffening.
- Understanding the interplay between LV function and arterial stiffness is crucial for cardiovascular health assessment.
Purpose of the Study:
- To investigate the relationship between Doppler-derived LV systolic and diastolic function indexes and arterial stiffness.
- To explore these associations in a large, population-based cohort.
Main Methods:
- 1233 participants underwent conventional and tissue Doppler imaging to assess LV velocities and strain.
- Arterial stiffness was evaluated using applanation tonometry, measuring central pulse pressure (cPP), augmentation pressure, and pulse wave velocity.
- Statistical analyses were performed after full adjustment for relevant covariates.
Main Results:
- Increased augmentation pressure and cPP were associated with higher transmitral E and A peaks and e' velocity.
- The E/e' ratio significantly increased with higher augmentation pressure, cPP, and pulse wave velocity.
- Arterial stiffness indexes were significantly higher in participants with diastolic dysfunction and elevated filling pressures.
- Longitudinal strain decreased with mean arterial pressure, and the correlation between radial strain and arterial stiffness was age-dependent.
Conclusions:
- Arterial characteristics play a significant role in mediating LV systolic and diastolic dysfunction.
- An age-dependent relationship exists between radial strain and arterial stiffness indexes, underscoring vascular aging's impact on cardiac mechanics.
Background:
Late-systolic loading of the left ventricular (LV) is determined by arterial wave reflections and central vascular stiffening. We, therefore, investigated the relationship between various Doppler indexes reflecting LV systolic and diastolic function and arterial stiffness in the framework of a large population study of randomly recruited study participants.
Methods:
In 1233 study participants (51.7% women; mean age, 48 years; 41.5% hypertensive), using conventional and tissue Doppler imaging, we measured: the transmitral early (E) and late (A) diastolic velocities; tissue Doppler imaging systolic and early (e') and late diastolic mitral annular velocities; and end-systolic longitudinal and radial strain. Using applanation tonometry, we assessed central pulse pressure (cPP), augmentation pressure and carotid-femoral pulse wave velocity.
Results:
After full adjustment, transmitral E and A peaks increased with augmentation pressure and cPP (P less than 0.0001) and e' was positively associated with cPP (P = 0.013). The E/e' ratio increased significantly with augmentation pressure (P less than 0.0001), cPP (P less than 0.0001) and pulse wave velocity (P = 0.048). Although accounting for covariables, all arterial indexes were on average significantly higher in the diastolic dysfunction group with elevated filling pressure (n = 171) when compared to participants with normal diastolic function (n = 961; P ≤ 0.0004) or with impaired relaxation (n = 101; P ≤ 0.008). Longitudinal strain decreased independently with mean arterial pressure (P = 0.03). The correlation between radial strain and the arterial indexes shifted from positive at middle age (50-60 years) to negative at older (P less than 0.0001 for interaction).
Conclusion:
Our study underscored the importance of arterial characteristics as a mediator of LV systolic and diastolic dysfunction. We demonstrated an age-dependent relationship between radial strain and indexes of arterial stiffness.
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