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. 2011 Mar;29(3):574-82.
doi: 10.1097/HJH.0b013e328342ca56.

Arterial wave reflection and subclinical left ventricular systolic dysfunction

Cesare Russo  1 , Zhezhen Jin, Yasuyoshi Takei, Takuya Hasegawa, Shun Koshaka, Vittorio Palmieri, Mitchell Sv Elkind, Shunichi Homma, Ralph L Sacco, Marco R Di Tullio
Affiliations

Arterial wave reflection and subclinical left ventricular systolic dysfunction

Cesare Russo et al. J Hypertens. 2011 Mar.

Abstract

Objectives: Increased arterial wave reflection is a predictor of cardiovascular events and has been hypothesized to be a cofactor in the pathophysiology of heart failure. Whether increased wave reflection is inversely associated with left-ventricular (LV) systolic function in individuals without heart failure is not clear.

Methods: Arterial wave reflection and LV systolic function were assessed in 301 participants from the Cardiovascular Abnormalities and Brain Lesions (CABL) study using two-dimensional echocardiography and applanation tonometry of the radial artery to derive central arterial waveform by a validated transfer function. Aortic augmentation index (AIx) and wasted energy index (WEi) were used as indices of wave reflection. LV systolic function was measured by LV ejection fraction (LVEF) and tissue Doppler imaging (TDI). Mitral annulus peak systolic velocity (Sm), peak longitudinal strain and strain rate were measured. Participants with history of coronary artery disease, atrial fibrillation, LVEF less than 50% or wall motion abnormalities were excluded.

Results: Mean age of the study population was 68.3 ± 10.2 years (64.1% women, 65% hypertensive). LV systolic function by TDI was lower with increasing wave reflection, whereas LVEF was not. In multivariate analysis, TDI parameters of LV longitudinal systolic function were significantly and inversely correlated to AIx and WEi (P values from 0.05 to 0.002).

Conclusions: In a community cohort without heart failure and with normal LVEF, an increased arterial wave reflection was associated with subclinical reduction in LV systolic function assessed by novel TDI techniques. Further studies are needed to investigate the prognostic implications of this relationship.

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Conflict of interest statement

Conflict of interest: None.

Figures

Figure 1
Figure 1. Tissue Doppler analysis of the LV longitudinal systolic function
Peak systolic longitudinal strain rate (A) and strain (B) measured at the mid-level of the ventricular septum. AVO: aortic valve opening. AVC: aortic valve closing. MVO: mitral valve opening. (C) Pulsed tissue Doppler of the septal mitral annulus.
Figure 1
Figure 1. Tissue Doppler analysis of the LV longitudinal systolic function
Peak systolic longitudinal strain rate (A) and strain (B) measured at the mid-level of the ventricular septum. AVO: aortic valve opening. AVC: aortic valve closing. MVO: mitral valve opening. (C) Pulsed tissue Doppler of the septal mitral annulus.
Figure 2
Figure 2. Arterial pulse waveform analysis by applanation tonometry
Radial (left) and aortic (right) waveforms. Aortic waveform is generated with a transfer function from radial artery waveform. pSBP: peripheral systolic blood pressure. pDBP: peripheral diastolic blood pressure: pPP: peripheral pulse pressure. cSBP: central systolic blood pressure. cDBP: central diastolic blood pressure: cPP: central pulse pressure. AP: augmented pressure. Tr: time to the beginning of the reflected wave. ED: ejection duration. The aortic augmentation index is calculated as 100 × AP/cPP. The striped area represents the area of under the reflected wave (wasted energy, WE) due to the return of the arterial wave from the reflection sites of the lower body. The gray area is the total systolic effort (pressure-time integral, PTI) of the systolic curve. The wasted energy index (WEi) is calculated as 100*WE/PTI.
Figure 3
Figure 3. Bland-Altman plots showing inter-observer reproducibility of LV systolic function by TDI
A: Peak mitral annulus systolic velocity (Sm). B: Peak LV longitudinal systolic strain. C: Peak LV longitudinal systolic strain rate.
Figure 3
Figure 3. Bland-Altman plots showing inter-observer reproducibility of LV systolic function by TDI
A: Peak mitral annulus systolic velocity (Sm). B: Peak LV longitudinal systolic strain. C: Peak LV longitudinal systolic strain rate.
See this image and copyright information in PMC

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