Association of Aortic Stiffness With Left Ventricular Remodeling and Reduced Left Ventricular Function Measured by Magnetic Resonance Imaging: The Multi-Ethnic Study of Atherosclerosis

Abstract

Background: This study sought to assess cross-sectional associations of aortic stiffness assessed by magnetic resonance imaging with left ventricular (LV) remodeling and myocardial deformation in the Multi-Ethnic Study of Atherosclerosis (MESA).

Methods and results: Aortic arch pulse wave velocity (PWV) was measured with phase contrast cine magnetic resonance imaging. LV circumferential strain (Ecc), torsion, and early diastolic strain rate were determined by tagged magnetic resonance imaging. Multivariable linear regression models were used to adjust for demographics and cardiovascular risk factors. Of 2093 participants, multivariable linear regression models demonstrated that higher arch PWV was associated with higher LV mass index (B=0.53 per 1 SD increase for log-transformed PWV, P<0.05) and LV mass to volume ratio (B=0.015, P<0.01), impaired LV ejection fraction (LVEF; B=-0.84; P<0.001), Ecc (B=0.55; P<0.001), torsion (B=-0.11; P<0.001), and early diastolic strain rate (B=-0.003; P<0.05). In sex stratified analysis, higher arch PWV was associated with higher MVR (B=0.02; P<0.05), impaired Ecc (B=0.60; P<0.001), and LVEF (B=-0.45; P<0.05), but with maintained torsion in women. Higher PWV was associated with impaired Ecc (B=0.49; P<0.001) and LVEF (B=-1.21; P<0.001), with lower torsion (B=-0.17; P<0.001) in men.

Conclusions: Higher arch PWV is associated with LV remodeling, and reduced LV systolic and diastolic function in a large multiethnic population. Greater aortic arch stiffness is associated with concentric LV remodeling and relatively preserved LVEF with maintained torsion in women, whereas greater aortic arch stiffness is associated with greater LV dysfunction demonstrated as impaired Ecc, torsion, and LVEF, with less concentric LV remodeling in men.

Keywords: epidemiology; heart ventricles; magnetic resonance imaging; pulse wave analysis; vascular stiffness.

Figure 1

Measurement for aortic arch PWV. A: Phase contrast cine transverse view. B: Aortic arch view with SSFP sequence. C: Measurement of the transit distance in the aortic arch. Numbers correspond to those in A and B. Arch length is measured as the distance from 3 to 11 in this case. D: Flow wave curves of ascending (Asc.) aorta and descending (Desc.) aorta after peak flow normalization. Transit time is measured as the average time difference using the least squares estimate between all data points on the systolic upslope of the ascending and descending aortic flow curves. PWV is calculated as transit distance divided by transit time.

Figure 2

Analysis for the tagged cardiovascular magnetic resonance imaging with a sample circumferential strain curve. A: Tagged short-axis images with 2 orthogonally oriented parallel striped tags at basal (1,4), midventricular (2, 5), and apical (3,6) levels. B: Imaging analysis–epicardial, endocardial and midwall borders of tagged LV wall image through an entire cardiac cycle. C: Color map showing pixelwise distribution of circumferential strain – more negative values indicate greater contraction. The values from the blood pool are extremely noise. D: Circumferential strain curves with each curve representing a segment.

Figure 3

Plots showing linear regression fits with 95%CI for women and men with left ventricular (LV) function variables on the y axis and logPWV on the x. Abbreviation as Table 1.