title: Arterial wave reflection and subclinical left ventricular systolic dysfunction.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Columbia University, College of Physicians & Surgeons, 630 West 168th Street, New York, NY 10032, USA.
authors.forename: Cesare
authors.initials: C
authors.lastname: Russo
authors.forename: Zhezhen
authors.initials: Z
authors.lastname: Jin
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Takei
authors.forename: Takuya
authors.initials: T
authors.lastname: Hasegawa
authors.forename: Shun
authors.initials: S
authors.lastname: Koshaka
authors.forename: Vittorio
authors.initials: V
authors.lastname: Palmieri
authors.forename: Mitchell Sv
authors.initials: MS
authors.lastname: Elkind
authors.forename: Shunichi
authors.initials: S
authors.lastname: Homma
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
authors.forename: Marco R
authors.initials: MR
authors.lastname: Di Tullio
mesh_terms: D000328:Adult; D000368:Aged; D001158:Arteries / Q000502:physiology*; D002318:Cardiovascular Diseases / Q000209:etiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013318:Stroke Volume; D013599:Systole; D018615:Ultrasonography, Doppler, Color; D018487:Ventricular Dysfunction, Left / Q000209:etiology*; D016277:Ventricular Function, Left