Arterial Stiffness and Arterial Wave Reflections Are Associated With Systolic and Diastolic Function in Patients With Normal Ejection Fraction

• Published in: American journal of hypertension 2008-11, Vol.21 (11), p.1194-1202
• Main Authors: Weber, Thomas, O'Rourke, Michael F., Ammer, Marcus, Kvas, Erich, Punzengruber, Christian, Eber, Bernd
• Format: Article
• Language: English
• Subjects: Aged; Arterial hypertension. Arterial hypotension; Biological and medical sciences; Blood and lymphatic vessels; Blood Flow Velocity - physiology; Blood Pressure - physiology; Cardiology. Vascular system; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Coronary Angiography; Coronary Artery Disease - physiopathology; Coronary Vessels - physiopathology; Diabetes Mellitus - physiopathology; Elasticity - physiology; Female; Humans; Hypertension - physiopathology; Logistic Models; Male; Medical sciences; Middle Aged; Prospective Studies; Regional Blood Flow - physiology; Stroke Volume - physiology
• ISSN: 0895-7061; 1941-7225; 1879-1905
• DOI: 10.1038/ajh.2008.277

Background Increased arterial stiffness and early wave reflections have been observed in patients with heart failure and normal ejection fraction (HFNEF). We investigated, whether impaired arterial function is associated with impaired systolic and diastolic function and symptomatic status. Methods We prospectively enrolled 336 patients (mean age 63.5 years) undergoing coronary angiography, and assessed pulse wave velocity (PWV) invasively, arterial wave reflections (augmentation index (AIx); pressure augmentation (AP)) noninvasively using radial applanation tonometry and a validated transfer function, and characteristic impedance (Zc) using echocardiography with tonometry. In addition, echocardiography including tissue Doppler of the mitral annulus was performed. Results Peak systolic velocity (S′) varied inversely with AIx (R = −0.38, P < 0.001), AP (R = −0.48, P < 0.0001), PWV (R = −0.39, P < 0.001), and Zc (R = −0.29, P < 0.01). Likewise, early diastolic velocity (E′) showed a strong, negative correlation with AP (R = −0.32, P < 0.01), PWV (R = −0.64, P < 0.0001), and Zc (R = −0.50, P < 0.0001). Higher filling pressures were associated with increased wave reflections (AIx, AP) and arterial stiffness (PWV, Zc). All associations were independent of age and gender. Patients suffering from exertional dyspnea had increased AIx, AP, and PWV. Conclusions In middle-aged and elderly patients, increased arterial stiffness and wave reflections are consistently and independently associated with impaired systolic and diastolic function and with functional limitations.