Doppler indexes of left ventricular systolic and diastolic function in relation to haemodynamic load components in a
Nicholas Cauwenberghs1, Judita Knez2, José Boggia3
1Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Belgium.
Insights
Central pulsatility impacts left ventricular (LV) function through forward (Pf) and backward (Pb) waves. Central pulse pressure (cPP) effectively predicts LV dysfunction, especially when age-related hemodynamic changes are considered.
Area of Science:
- Cardiovascular Physiology
- Biomedical Engineering
- Clinical Echocardiography
Background:
- Central pulsatility, comprising forward (Pf) and backward (Pb) pulse waves, may contribute to left ventricular (LV) dysfunction.
- Investigating the relationship between echocardiographic LV function indices and pulsatile hemodynamic loads is crucial.
Purpose of the Study:
- To examine the association between echocardiographic measures of LV function and pulsatile hemodynamic loads.
- To evaluate the utility of wave separation analysis (WSA) in deriving these hemodynamic parameters.
Main Methods:
- Wave separation analysis (WSA) was used to calculate central pulse pressure (cPP), Pf, and Pb from radial tonometric recordings in 616 participants.
- Echocardiographic assessments included LV dimensions, transmitral blood flow, and mitral annular tissue velocities.
- Multivariable analyses were performed to identify factors associated with hemodynamic loads and LV function.
Main Results:
- Age significantly influenced cPP, Pf, Pb, and reflection magnitude, and altered the Pf-Pb correlation.
- Hemodynamic loads were associated with sex, BMI, heart rate, mean arterial pressure, diabetes, and antihypertensive medication use.
- Higher cPP, Pf, and Pb were linked to increased transmitral velocities and E/e' ratio, with age-dependent associations observed for LV radial strain.
Conclusions:
- The commercial WSA algorithm has limited clinical feasibility, particularly in older individuals with unfavorable hemodynamics.
- LV function indices showed similar associations with Pf and Pb.
- Central pulse pressure (cPP) is favored for predicting LV dysfunction due to its composite nature and predictive capability.
Background:
The contribution of central pulsatility to left ventricular (LV) dysfunction might be mediated by the haemodynamic loads of forward (Pf) and backward (Pb) pulse waves. We investigated the relation between echocardiographic indexes of LV function and pulsatile loads derived by wave separation analysis (WSA).
Methods:
In 755 participants, we assessed LV dimensions, transmitral blood flow and mitral annular tissue velocities. We derived central pulse pressure (cPP) from radial tonometric recordings and calculated Pf, Pb and their ratio (reflection magnitude) using an automated, pressure-based WSA algorithm. Despite good quality recordings, WSA failed to derive Pf and Pb in 139 participants (18.4%), in particular in older women with unfavourable haemodynamics. Thus, our analysis included 616 participants (46.1% women; mean age, 49.2 years).
Results:
Age and age explained most of the variance in cPP (36.9%), Pf (18.6%), Pb (41.5%) and reflection magnitude (36.7%; P < 0.0001) and altered the direct correlation between Pf and Pb (Pint < 0.0001). Haemodynamic loads were independently associated with sex, BMI, heart rate, mean arterial pressure, history of diabetes and use of antihypertensive drugs. In multivariable-adjusted analyses, transmitral velocities and E/e' ratio increased with higher cPP, Pf and Pb in men and women. We also observed an age-dependent association of LV radial strain with cPP, Pf and Pb.
Conclusion:
The commercial WSA algorithm holds limited clinical utility given its low feasibility in older participants with unfavourable haemodynamics. LV function indexes were similarly associated with Pf and Pb, favouring the use of the composite cPP for prediction of LV dysfunction.
Related Concept Videos
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:26Imbalances in Cardiac Output
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...