Association of Increased Arterial Stiffness and P Wave Dispersion with Left Ventricular Diastolic Dysfunction

Abstract

Background: The association between increased arterial stiffness and left ventricular diastolic dysfunction (LVDD) may be influenced by left ventricular performance. P wave dispersion is not only a significant determinant of left ventricular performance, but is also correlated with LVDD. This study is designed to compare left ventricular diastolic function among patients divided by brachial-ankle pulse wave velocity (baPWV) and corrected P wave dispersion (PWDC) and assess whether the combination of baPWV and PWDC can predict LVDD more accurately.Methods: This cross-sectional study enrolled 270 patients and classified them into four groups according to the median values of baPWV and PWDC. LVDD was defined as impaired relaxation and pseudonormal/restrictive mitral inflow patterns.Results: The ratio of transmitral E wave velocity to early diastolic mitral annulus velocity (E/Ea) was higher in group with higher baPWV and PWDC than in the other groups (all p <0.001). The prevalence of LVDD was higher in group with higher baPWV and PWDC than in the two groups with lower baPWV (p ≤ 0.001). The baPWV and PWDC were correlated with E/Ea and LVDD in multivariate analysis (p ≤ 0.030). The addition of baPWV and PWDC to a clinical mode could significantly improve the R square in prediction of E/Ea and C statistic and integrated discrimination index in prediction of LVDD (p ≤ 0.010).Conclusions: This study showed increased baPWV and PWDC were correlated with high E/Ea and LVDD. The addition of baPWV and PWDC to a clinical model improved the prediction of high E/Ea and LVDD. Screening patients by means of baPWV and PWDC might help identify the high risk group of elevated left ventricular filling pressure and LVDD.

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

“…Therefore, LV long-axis shortening and GLS may be reduced when pulling against a stiffer aorta because of a potential mechanical ventricular-vascular interaction. Both increased aortic stiffness and impaired GLS have been associated with impaired LV diastolic function in previous studies 12,19,34,35,38,[42][43][44][45][46][47] as well as in our cohort. 48 The relation between aortic stiffness and diastolic function is often attributed to hemodynamic effects, while the relation between GLS and diastolic function has been attributed to recoil of contracted LV muscle fibers.…”

“…Increased aortic stiffness has been linked to impaired LV systolic function, particularly along the LV long axis. [34][35][36][37][38][39] The relation is often attributed to increased hemodynamic load imposed by stiffer arteries. 36,40 However, our observed relations between aortic stiffness measures and GLS persisted after adjusting for traditional measures of hemodynamic load.…”

Association between reduced arterial stiffness and preserved diastolic function of the left ventricle in middle‐aged and elderly patients

“…The association between arterial stiffness and LV diastolic function has been investigated in many studies. Although arterial stiffness has been assessed using different methods, such as aortic dimension and strain on echocardiography, the pulse pressure method, and baPWV, the close relationship between LV diastolic function and arterial stiffness is consistent among studies. A recent study performed by our group demonstrated an independent association between baPWV and global longitudinal strain of LV, supporting the evidence that increased arterial stiffness may result in impaired LV longitudinal function .…”

Impact of Pulse Wave Velocity and Parameters Reflecting Android Type Fat Distribution on Left Ventricular Diastolic Dysfunction in Patients with Chronic Coronary Syndromes

“…Carotid-femoral PWV has also been shown to be useful in identifying preclinical LVDD that outperformed central and brachial pulse pressure [39]. Tsai et al [40] examined a group of patients with suspected coronary artery disease, heart failure, hypertension, abnormal cardiac physical examination, survey for dyspnea and the pre-operative cardiac function survey. He has proven that patients with higher brachial-ankle PWV had higher prevalence of LVDD.…”