Interplay between arterial stiffness and diastolic function: a marker of ventricular-vascular coupling.
OBJECTIVE
We evaluated the interplay between left ventricular diastolic function and large-artery stiffness in asymptomatic patients at increased risk of heart failure and no structural heart disease (Stage A).


METHODS
We divided 127 consecutive patients (mean age 49 ± 17 years) with risk factors for heart failure who were referred to our laboratory to rule out structural heart disease into two groups according to presence (Group 1, n = 35) or absence (Group 2, n = 92) of grade I left ventricular diastolic dysfunction. Doppler imaging with high-resolution echo-tracking software was used to measure intima-media thickness (IMT) and stiffness of carotid arteries.


RESULTS
Group 1 had significantly higher mean age, blood pressure, left ventricular mass index, carotid IMT and arterial stiffness than Group 2 (P < 0.05). Overall, carotid stiffness indices (β-stiffness index, augmentation index and elastic modulus) and 'one-point' pulse wave velocity each showed inverse correlation with E-wave velocity, E' velocity and E/A ratio, and direct correlation with A-wave velocity, E-wave deceleration time and E/E' ratio (P < 0.05). Arterial compliance showed negative correlations with the echocardiographic indices of left ventricular diastolic function (P < 0.05). On logistic regression analysis, age, hypertension, SBP, pulse pressure, left ventricular mass index, carotid IMT and stiffness parameters were associated with grade I left ventricular diastolic dysfunction (P < 0.05 for each). However, on multivariate logistic analysis, only 'one-point' pulse wave velocity and age were independent predictors (P = 0.038 and P = 0.016, respectively).


CONCLUSIONS
An independent association between grade I left ventricular diastolic dysfunction and increased arterial stiffness is demonstrated at the earliest stage of heart failure. Hence, assessment of vascular function, beyond cardiac function, should be included in a comprehensive clinical evaluation of these patients.
aCardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy bAurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin, USA cCardiology Unit, El Minia University Hospital, El Minia, Egypt dCardiology Unit, ARC, Santa Maria degli Angeli Hospital, Pordenone eCardiology Department, San Antonio Hospital, San Daniele del Friuli, Udine, Italy.
Concetta
C
Zito
Moemen
M
Mohammed
Maria Chiara
MC
Todaro
Bijoy K
BK
Khandheria
Maurizio
M
Cusmà-Piccione
Giuseppe
G
Oreto
Pietro
P
Pugliatti
Mohamed
M
Abusalima
Francesco
F
Antonini-Canterin
Olga
O
Vriz
Scipione
S
Carerj
D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D003971:Diastole / Q000502:physiology*; D015150:Echocardiography, Doppler / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006352:Heart Ventricles / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis / Q000379:methods; D059289:Vascular Stiffness / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology; D016277:Ventricular Function, Left / Q000502:physiology