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Ventricular-Arterial Uncoupling and Hypertension Mediated Diastolic Dysfunction

Daniel Piskorz1, Luis Keller2, Luciano Citta2

  • 1Cardiology Institute of the Rosario British Sanatorium, Jujuy 1540, floor 5th, 2000, Rosario, Argentina. danielpiskorz@ciudad.com.ar.

High Blood Pressure & Cardiovascular Prevention : the Official Journal of the Italian Society of Hypertension
|April 23, 2022
PubMed

Insights

Ventricular-arterial uncoupling, a mismatch between the left ventricle and arteries, is common in hypertension. This study found that impaired ventricular-arterial coupling is linked to increased left ventricular hypertrophy and diastolic dysfunction.

Area of Science:

  • Cardiology
  • Physiology
  • Hypertension Research

Background:

  • Increased pulsatile afterload in hypertension can cause left ventricular (LV) afterload mismatch.
  • Ventricular-arterial uncoupling is a suspected contributor to LV dysfunction in hypertensive patients.

Purpose of the Study:

  • To determine the prevalence of ventricular-arterial uncoupling in hypertensive patients with preserved ejection fraction.
  • To investigate the association between ventricular-arterial uncoupling, LV hypertrophy (LVH), and diastolic dysfunction (DD).

Main Methods:

  • Observational study of 288 hypertensive patients with ejection fraction > 54%.
  • Utilized 2D echocardiography and tissue Doppler to assess LV function.
  • Measured end-systolic elastance (Ees), effective arterial elastance (Ea), and ventricular-arterial coupling (VAC) using the Chen single-beat method.

Main Results:

  • Ventricular-arterial uncoupling (VAC) was frequently observed.
  • Patients with the worst VAC showed significantly increased LV stroke volume and stroke work.
  • Conversely, patients with the worst VAC had significantly reduced systolic stress and peripheral resistance index.
  • The frequency of LVH or DD was significantly higher in patients with the worst VAC.

Conclusions:

  • Ventricular-arterial uncoupling is prevalent in hypertension and associated with adverse LV remodeling.
  • Impaired VAC is primarily driven by increased LV end-systolic elastance (Ees) rather than elevated arterial elastance (Ea).
  • Ventricular-arterial uncoupling is a significant risk factor for developing LV hypertrophy and diastolic dysfunction in hypertensive individuals.
Abstract

Keywords:
Diastolic dysfunctionHypertensionLeft ventricle hypertrophyVentricular-arterial uncoupling

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