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Association of arterial hemodynamics with left ventricular systolic function in hypertensive patients: A longitudinal
Anna Teresa Goździk1, Ewelina Jasic-Szpak1, Jakub Michałowicz2
1Institute of Heart Diseases, Wroclaw Medical University, Poland.
Insights
Changes in left ventricular function in hypertensive patients are linked to arterial stiffness and ventricular-arterial coupling. Improved longitudinal strain correlated with better hemodynamics and coupling over 12 months.
Area of Science:
- Cardiology
- Hypertension Research
- Cardiovascular Physiology
Background:
- Left ventricular (LV) systolic impairment, especially longitudinal, is an early marker of hypertensive heart disease and cardiovascular risk.
- Aortic stiffness and central hemodynamics significantly influence LV performance and the heart-vascular load interaction.
- Longitudinal data on LV mechanics during antihypertensive treatment are lacking.
Purpose of the Study:
- To examine associations between changes in LV longitudinal and circumferential function and alterations in arterial hemodynamics and ventricular-arterial coupling (VAC).
- To investigate these associations over a 12-month follow-up period in hypertensive patients undergoing antihypertensive therapy.
Main Methods:
- Retrospective study of 216 hypertensive patients.
- Echocardiography for LV longitudinal strain (GLS) and circumferential strain (GCS), brachial BP, and VAC.
- Radial tonometry for arterial hemodynamics at baseline and 12 months.
- Patients categorized by GLS improvement or deterioration.
Main Results:
- Patients with improved GLS showed favorable changes in pulse wave velocity, central augmentation pressure, and VAC compared to those with GLS deterioration.
- Baseline GLS and changes in central augmentation pressure and VAC independently predicted changes in GLS.
- Baseline GCS and changes in central augmentation pressure independently predicted changes in GCS.
Conclusions:
- Left ventricular longitudinal and circumferential functional remodeling in hypertensive patients is associated with arterial hemodynamics.
- Ventricular-arterial coupling plays a role in the longitudinal changes of LV function over time in hypertension.
Background:
Left ventricular (LV) systolic impairment, particularly in the longitudinal direction, is considered an early and sensitive marker of hypertensive heart disease and increased cardiovascular risk. The evidence indicates that aortic stiffness and central hemodynamic factors are important determinants of LV performance, mediating the interaction between the heart and vascular load. Despite the existence of cross-sectional analyses linking central blood pressure (BP) parameters with LV mechanics, no longitudinal data are available which include serial measurements in the course of antihypertensive treatment.
Objectives:
To investigate the associations between changes in LV longitudinal and circumferential function with alterations in arterial hemodynamics and ventricular-arterial coupling (VAC) in patients with uncomplicated hypertension during a 12-month follow-up.
Material And Methods:
In this retrospective study, 216 patients (age 64.3 ±7.6 years) underwent echocardiography including left ventricular longitudinal (GLS) and circumferential strain (GCS) analysis, brachial BP measurements, VAC (combining echocardiography and brachial BP), and arterial hemodynamics using radial tonometry at baseline and after 12 months of antihypertensive therapy. Patients were grouped into 2 subsets: with improvement in GLS (n = 103) and with deterioration in GLS (n = 113).
Results:
No significant differences were observed in the majority of cardiovascular, demographic or clinical characteristics between the groups. The subset with improvement in GLS demonstrated more favorable changes over follow-up in pulse wave velocity (p = 0.03), central augmentation pressure (p = 0.01) and ventricular-arterial coupling (p = 0.04) compared to patients showing deterioration in GLS. In the multivariable analysis, independent determinants of changes in GLS were: GLS at baseline (-0.48; p < 0.001), changes from baseline to follow-up in central augmentation pressure (-0.29; p = 0.002) and ventricular-arterial coupling (-0.25; p = 0.004). Independent determinants of analogous changes in GCS were: GCS at baseline (-0.46; p < 0.001) and changes in central augmentation pressure (-0.22; p = 0.02).
Conclusions:
Left ventricular longitudinal and circumferential functional remodeling over time in hypertensive patients is associated with arterial hemodynamics and ventricular-arterial coupling.
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