Cardiac Diastolic Dysfunction is Associated With Aortic Wave Reflection, but Not Stiffness in a Predominantly
Vernice R Peterson1, Angela J Woodiwiss1, Carlos D Libhaber2
1Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
Insights
Backward wave pressures (Pbs) impact left ventricular (LV) diastolic dysfunction (DD) before aortic stiffness or forward wave pressures (Pfs) do. This finding is crucial for understanding early preclinical DD in community samples.
Area of Science:
- Cardiovascular Physiology
- Clinical Cardiology
- Biomedical Engineering
Background:
- The precise timing of backward wave pressures (Pbs) impact on left ventricular (LV) diastolic dysfunction (DD) relative to aortic stiffness remains unclear.
- Understanding preclinical DD is vital for early intervention and cardiovascular risk stratification.
Purpose of the Study:
- To compare the relative contributions of various aortic hemodynamic parameters to preclinical DD.
- To investigate whether backward wave pressures precede the effects of aortic stiffness on LV diastolic function.
Main Methods:
- 524 participants of African ancestry underwent applanation tonometry for aortic hemodynamic assessment (PPc, Pf, Pb, Pa, Rt, PWV).
- Echocardiography was used to evaluate LV mass index (LVMI), E/A, and E/e' to assess diastolic function.
- Statistical analyses adjusted for multiple confounders including age, sex, BMI, diabetes, smoking, alcohol, hypertension treatment, and LVMI.
Main Results:
- Backward wave pressure (Pb) was independently associated with E/e' (P < 0.0005) and moderate-to-severe DD (E/e' ≥ 12, P < 0.002), even after adjusting for confounders.
- Central aortic pulse pressure (PPc), augmented pressure (Pa), and forward wave pressure (Pf) also showed independent associations with E/e', but Pb's association was most robust.
- The independent relationship between PPc and DD was abolished when adjusted for Pb, suggesting Pb's primary role.
Conclusions:
- In a community sample, backward wave pressures (Pbs) significantly impact left ventricular diastolic dysfunction (DD) earlier than aortic stiffness, wave reflection time, or forward wave pressures.
- These findings highlight the critical role of backward wave pressures in the early pathogenesis of diastolic dysfunction.
- This research provides valuable insights for developing targeted strategies for the prevention and management of preclinical diastolic dysfunction.
Background:
Whether the impact of backward wave pressures (Pbs) on left ventricular (LV) diastolic dysfunction (DD) antedates the effects of aortic stiffness is uncertain. We compared the relative contribution of various aortic hemodynamic parameters to preclinical DD in a predominantly young-to-middle-aged community-based sample.
Methods:
In 524 randomly selected participants of African ancestry (mean age = 46.8±18.4 years), we assessed central aortic pulse pressure (PPc), forward wave pressure (Pf), Pb, augmented pressure (Pa), the time-to-wave reflection (Rt), and aortic pulse wave velocity (PWV) using applanation tonometry (SphygmoCor software). LV mass index (LVMI), early to late transmitral velocity (E/A), and E/velocity of myocardial tissue lengthening (E/e') were determined using echocardiography.
Results:
Independent of age, sex, mean arterial pressure, body mass index, diabetes mellitus and/or HbA1c > 6.1%, regular smoking, regular alcohol intake, treatment for hypertension, pulse rate, and LVMI; PPc (P < 0.002), Pb (P < 0.0005), Pa (P < 0.002), and Pf (P < 0.02), but not Rt or PWV were independently associated with E/e' (but not with E/A). With adjustments for confounders, PPc (P < 0.005), Pb (P < 0.002), and Pa (P < 0.001), but not Pf, Rt, or PWV were independently associated with E/e' ≥ 12 (moderate-to-severe DD, n = 69). The independent relations between PPc and E/e' or moderate-to-severe DD were not affected by adjustments for PWV, Pf, or Rt, but were abolished with adjustments for Pb.
Conclusions:
In a predominantly young-to-middle-aged community sample, the impact of Pbs on LV DD antedates the effects of aortic stiffness, the time-to-wave reflection, or Pfs.
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