Interrelations of aortic spring function, cardiovascular disease risk factors, and left ventricular diastolic...

Mechanical twisting and untwisting of the left ventricle as well as abnormal hemodynamic aortic-ventricular coupling are recognized as contributors to left ventricular diastolic function. However, energy associated with proximal aortic stretch during systole can be recovered as diastolic elastic recoil that may facilitate diastolic left ventricular filling. To investigate this "aortic spring" mechanism, we assessed the cross-sectional and longitudinal associations of systolic atrioventricular plane displacement (AVPD), a surrogate measure of stretch of the mechanically coupled ascending aorta, with measures of left ventricular diastolic function. At two examinations (14 ± 1 years apart) in Framingham Heart Study participants (N = 7117; mean age 50 years, 55% women), we assessed AVPD and left ventricular diastolic function using echocardiography. In cross-sectional analyses, higher AVPD was associated with higher e' (β per SD ± standard error = 0.49 ± 0.01; p < 0.001) and lower E/e' (β = -0.39 ± 0.01; p < 0.001). In longitudinal models, greater change in (Δ) AVPD between visits was associated with higher Δe' (β = 0.38 ± 0.01; p < 0.001) and lower ΔE/e' (β = -0.19 ± 0.01; p < 0.001). We observed effect modification (interaction p-values: <0.001 to 0.03) for cross-sectional and longitudinal associations by median age, sex, obesity status, hypertension treatment, and the extent of aortic stiffness (assessed via carotid-femoral pulse wave velocity). Thus, the aortic spring function may contribute to left ventricular diastolic function.