title: Associations of Alterations in Pulsatile Arterial Load With Left Ventricular Longitudinal Strain.
abstract: BACKGROUND
  Increased arterial stiffness leads to increased pulsatile load on the heart. We investigated associations of components of pulsatile load with a measure of left ventricular (LV) systolic function-global longitudinal strain (GLS), in a community-based cohort ascertained based on family history of hypertension.
  
  
  METHODS
  Arterial tonometry and echocardiography with speckle tracking were performed in 520 adults with normal LV ejection fraction (EF) (age 67±9 years, 70% hypertensive) to quantify measures of pulsatile load (characteristic aortic impedance (Zc), total arterial compliance (TAC), and augmentation index (AI)) and GLS. The associations of log-Zc, log-TAC, and AI with GLS were assessed using sex-specific z-scores for each measure of arterial load.
  
  
  RESULTS
  In univariable analyses, higher Zc was associated with worse GLS (less negative) and higher TAC and AI were associated with better GLS (all P < 0.001). In a multivariable model including age, sex, heart rate (HR), LVEF, mean arterial load (systemic vascular resistance), and measures of pulsatile load, Zc remained associated with GLS (β = 0.28, P < 0.001), while the associations of TAC and AI were no longer significant (P > 0.5). Additional adjustment for cardiovascular risk factors and history of coronary heart disease and stroke did not attenuate the association of Zc with GLS; Zc, sex, HR, LVEF remained associated with GLS after stepwise elimination (all P < 0.001).
  
  
  CONCLUSIONS
  Greater proximal aortic stiffness, as manifested by a higher Zc, is independently associated with worse LV longitudinal function.
authors.affiliation: Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Zi
authors.initials: Z
authors.lastname: Ye
authors.affiliation: Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Thais
authors.initials: T
authors.lastname: Coutinho
authors.affiliation: Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Pellikka
authors.affiliation: Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Hector R
authors.initials: HR
authors.lastname: Villarraga
authors.affiliation: Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA.
authors.forename: Barry A
authors.initials: BA
authors.lastname: Borlaug
authors.affiliation: Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic, Rochester, Minnesota, USA. kullo.iftikhar@mayo.edu.
authors.forename: Iftikhar J
authors.initials: IJ
authors.lastname: Kullo
mesh_terms: D000368:Aged; D001011:Aorta / Q000503:physiopathology*; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D006352:Heart Ventricles / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011673:Pulsatile Flow / Q000502:physiology*; D012307:Risk Factors; D013223:Statistics as Topic; D013318:Stroke Volume; D059289:Vascular Stiffness / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000473:pathology / Q000503:physiopathology; D016277:Ventricular Function, Left
keywords: aortic characteristic impedance; arterial load; arterial–ventricular interaction; blood pressure; hypertension; left ventricular deformation; left ventricular function; speckle tracking echocardiography.
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