Prolonged mechanical systole and increased arterial wave reflections in diastolic dysfunction

Weber, Thomas; Auer, Johann; O’Rourke, Michael; Punzengruber, Christian; Kvas, Erich; Eber, Bernd

doi:10.1136/hrt.2005.084145

Cited by 93 publications

(65 citation statements)

References 32 publications

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“…Recently, it has been shown that arterial wave reflections are increased in patients with LV diastolic dysfunction who were referred for coronary angiography. 26 Similarly, in this study, patients with LV diastolic dysfunction had increased wave reflections than patients without LV diastolic dysfunction. Univariate analysis revealed that CAI and AoS are determinants of LV diastolic dysfunction.…”

Section: Association Of Cai and Aos With LV Diastolic Dysfunctionsupporting

confidence: 62%

“…The increased cardiac workload and reduced diastolic period caused by the early arrival of high amplitude wave reflections is reflected by an increased CAI and may have contributed to the impairment of LV diastolic function as shown in Figure 1. 34 Studies have shown an association between increased indices of aortic stiffness and LV diastolic dysfunction in animal models, 12,27,34,35 in patients with CAD, 26 diabetes, 16 in obese subjects, 36 in treated hypertensive patients 13 and in patients with Adamantiades-Behcet syndrome. 10 However, to the best of our knowledge, we are the first to describe that in untreated patients with newly diagnosed hypertension, wave reflections are associated with LV diastolic dysfunction independently of age, gender, LVMI, AoS and BP parameters.…”

Section: Association Of Cai and Aos With LV Diastolic Dysfunctionmentioning

confidence: 99%

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Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

et al. 2008

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Systemic arterial stiffness is an indicator of cardiovascular disease and an independent marker of morbidity and cardiovascular mortality. We investigated the association of arterial wave reflections with left ventricular (LV) diastolic dysfunction and their incremental value to other determinants of LV diastolic dysfunction in patients with essential hypertension. In total 143 patients and 20 controls with similar atherosclerotic risk factors were examined by applanation tonometry of the radial artery (Sphygmocor) and echocardiography. Central augmentation index (CAI%) of reflected arterial waves as well as aortic strain (AoS) assessed by echocardiography were estimated. Doppler diastolic abnormalities were defined as proposed by the European Study Group on diastolic heart failure by measurement of E/A ratio (the ratio of the mitral inflow velocities), isovolumic relaxation time, deceleration time and flow propagation velocity. AoS and CAI were impaired in patients compared with controls (4.67 ± 2.94 vs 6.06 ± 4.91% and 145.8 ± 22.7 vs 135.7 ± 20.3%, Po0.01) as well as in patients with LV diastolic dysfunction compared to patients without, (5.52 ± 4.29 vs 10.73 ± 5.77% and 139.5 ± 21.7 vs 124.5 ± 17.0%, Po0.05). The odds ratio (OR) of AoS and CAI for diastolic dysfunction was OR:0.918, 95% confidence interval (CI):0.837-0.99, P ¼ 0.04 and OR:1.023, 95%CI: 1.023-1.040 P ¼ 0.010, respectively. The addition of CAI to the multivariable model including age, LV mass index, AoS and mean arterial pressure increased the power of the model for determination of LV diastolic dysfunction (À2 log likelihood ¼ 139.368, change of v 2 ¼ 4.2, P-value for change ¼ 0.04). In untreated patients with newly diagnosed essential hypertension, wave reflections are independent and additive determinants of LV diastolic dysfunction.

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Section: Association Of Cai and Aos With LV Diastolic Dysfunctionsupporting

confidence: 62%

Section: Association Of Cai and Aos With LV Diastolic Dysfunctionmentioning

confidence: 99%

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

et al. 2008

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“…In these patients, left ventricular contraction paradoxically is strong; heart failure is due to delayed relaxation and impaired ventricular filling in diastole, i.e. to diastolic heart failure [52]. The left ventricle of the patients acts as a flow source-it ejects strongly against the reflected wave, which is seen as augmentation of pressure in late systole.…”

Section: Change In Waveforms With Heart Failurementioning

confidence: 99%

“…The left ventricle of the patients acts as a flow source-it ejects strongly against the reflected wave, which is seen as augmentation of pressure in late systole. Ejection fraction of the left ventricle is not reduced; ejection duration may be lengthened [30,52].…”

Section: Change In Waveforms With Heart Failurementioning

confidence: 99%

Time domain analysis of the arterial pulse in clinical medicine

O’Rourke

2008

Med Biol Eng Comput

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The arterial pulse at any site is created by an impulse generated by the left ventricle as it ejects blood into the aorta, together with multiple impulses travelling in the opposite direction from reflecting sites in the peripheral circulation. The compound wave at any site depends on the pattern of ventricular ejection, the properties of large arteries, particularly their stiffness (which determines rate of propagation) and the distance to and impedance mismatch at reflecting sites. Physicians are familiar with waveform analysis in the time domain, as in the electrocardiogram (ECG) where the principal features are explicable on the basis of atrial depolarisation followed by ventricular depolarisation, then repolarisation. Effects of cardiac functional and structural disease can be inferred from the ECG. It is more difficult to make similar interpretations from the pulse waveform and clinicians usually use this only to count heart rate, extremes of the pressure pulse to express systolic and diastolic pressure, and (sometimes) time from wave foot to incisural notch to measure time of systole and diastole. More information can be gleaned from the shape of the arterial pressure wave through consideration of the factors which create it-on stiffening of large arteries with age, effects of drugs on smallest arteries, and changes in such arterial properties on left ventricular load and function. Such is a major challenge to future physicians. It is aided by better and more accurate methods for measuring flow and diameter as well as pressure waveforms, and by appropriate use of other analytic techniques such as analysis of the pulse in the frequency domain.

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“…78 Wave reflections influence myocardial work during late systole, resulting in greater myocardial stress, 101 a primary determinant of systolic function and myocardial oxygen demand. 102,103 Wave reflections arriving in late systole rather than diastole can impair diastolic function through decreased perfusion time, 104 and are inversely associated with the isovolumetric relaxation period. 105 Furthermore, LV early diastolic velocity, a measure of ventricular relaxation, is strongly associated with late systolic load, 106 which is substantially determined by wave reflections and central arterial stiffness.…”

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confidence: 99%

Arterial stiffness as a noninvasive tissue biomarker of cardiac target organ damage

Augustine¹,

Lefferts²,

Hughes³

et al. 2014

CBF

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Abstract:The primary prevention of cardiovascular (CV) disease is hindered by the inadequacy of traditional risk factors to stratify CV risk. The presence of cardiac target organ damage (cTOD), as detected by measures of left ventricular (LV) hypertrophy and dysfunction, is associated with future CV outcomes, but is not currently assessed in asymptomatic individuals. Arterial stiffness contributes to cTOD and may represent a biomarker that can detect vascular dysfunction before the clinical manifestations of cTOD. Measurement of arterial stiffness may provide insight into premature risk for cTOD and afford opportunity for early intervention to prevent further damage. The purpose of this review is to examine the utility of arterial stiffness as a noninvasive biomarker of subclinical cTOD. To this end, we will examine the evidence supporting the association between arterial stiffness and measures of cTOD. We will then explore the developmental origins of arterial stiffness and cTOD and outline the progression of CV damage that occurs with age. We discuss the mechanistic role of pressure from wave reflections as a crucial link between arterial stiffness and cTOD. Finally, we examine these associations in context by exploring sex and racial differences in arterial stiffness as related to cTOD. Our comprehensive examination of the literature suggests that early identification of arterial stiffness would be a useful biomarker of future cTOD risk.

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Prolonged mechanical systole and increased arterial wave reflections in diastolic dysfunction

Abstract: Mechanical systole is prolonged and arterial wave reflections are increased in most patients with DD. Rapid non-invasive assessment of these parameters may aid in confirming or excluding DD.

Cited by 93 publications

References 32 publications

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension

Time domain analysis of the arterial pulse in clinical medicine

Arterial stiffness as a noninvasive tissue biomarker of cardiac target organ damage

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