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Ventricular-arterial coupling assessed by PWV/GLS ratio in hypertensive patients
G Stoichescu-Hogea1, F N Buleu, G Nicusor Pop
1Department of Cardiology, "Victor Babes" University of Medicine and Pharmacy, Timisoara, Romania. buleu.florina@gmail.com.
Insights
The PWV/GLS ratio effectively detects altered ventricular-arterial coupling in hypertensive patients, offering a new tool for monitoring cardiovascular health and treatment efficacy.
Area of Science:
- Cardiology
- Vascular Physiology
- Biomedical Engineering
Background:
- Ventricular-arterial coupling (VAC) is crucial for optimal cardiac work and cardiovascular performance.
- Hypertension significantly impacts the interaction between the left ventricle and arterial system.
- Assessing VAC is vital for understanding cardiovascular health in hypertensive individuals.
Purpose of the Study:
- To evaluate the utility of the pulse wave velocity (PWV) to global longitudinal strain (GLS) ratio in assessing ventricular-arterial coupling (VAC).
- To compare VAC parameters in hypertensive patients with and without coronary artery disease against healthy controls.
- To identify a predictive threshold for altered VAC using the PWV/GLS ratio.
Main Methods:
- Calculated the PWV/GLS ratio in 135 participants across three groups: hypertensive patients with coronary artery disease (HT+CAD), hypertensive patients (HT), and healthy controls (CON).
- Measured pulse wave velocity (PWV) as a marker of arterial stiffness and global longitudinal strain (GLS) as a marker of left ventricular function.
- Utilized Receiver Operating Characteristic (ROC) curve analysis to determine the diagnostic threshold for altered VAC.
Main Results:
- Significantly reduced GLS and elevated PWV were observed in both HT+CAD and HT groups compared to controls (p<0.001).
- The PWV/GLS ratio was significantly lower in hypertensive groups (HT+CAD and HT) versus controls (p<0.001), indicating impaired VAC.
- An ROC curve analysis identified a PWV/GLS ratio threshold of -0.054 for detecting altered VAC with an AUROC of 0.836.
Conclusions:
- The PWV/GLS ratio is a valuable tool for detecting altered ventricular-arterial coupling in hypertensive patients.
- This ratio holds potential for monitoring early multi-organ damage and evaluating antihypertensive medication efficacy.
- Further extensive prospective studies are warranted to validate these findings and clinical applications.
Objective:
The physiological interaction between the left ventricle (LV) and the arterial system, defined as ventricular-arterial coupling (VAC), facilitates the optimal volume of cardiac work and cardiovascular performance. The aim of this study was to evaluate the benefit of PWV/GLS ratio associated with other vascular and cardiac performance parameters in hypertensive patients compared to age-matched healthy controls.
Patients And Methods:
We calculated the ratio of pulse wave velocity (PWV), as a marker of arterial stiffness, to global longitudinal strain (GLS), as a marker of left ventricular function in 135 patients divided in 3 groups, as follows: group 1 (HT + CAD) enrolled 54 hypertensive patients with coronary artery disease, group 2 (HT) enrolled 43 hypertensive patients and group 3 (CON) represented the control group consisting of 38 age-matched healthy subjects.
Results:
GLS values were significantly reduced in HT+CAD (-17.50±7.2) vs. HT (-17.95±5.3) vs. control (-20.13±4.6) (p-value <0.001). PWV values were higher in HT+CAD (9.90±3.1) and HT (9.70±2.5) vs. control (7.85±3.2) (p-value <0.001). VA coupling measured by the PWV/GLS ratio showed significantly lower values in HT+CAD and HT vs. control (p-value <0.001). The ROC curve identified a threshold of -0.054 of the PWV/GLS ratio to detect altered ventricular-arterial coupling AUROC = 0.836, 95% CI [0.762; 0.909].
Conclusions:
This study demonstrated that assessment of the PWV/GLS ratio represents a useful tool to detect altered ventricular-arterial coupling in hypertensive patients. The perspectives of future use could include monitoring of earlier development of multiple organ damage in hypertensive patients and the efficacy of the different hypertensive medications. Extensive prospective studies are needed to confirm this hypothesis.
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