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

Abstract

BackgroundAortic stiffness impairs optimal ventricular–vascular coupling and left ventricular systolic function, particularly in the long axis. Left ventricular global longitudinal strain (GLS) has recently emerged as a sensitive measure of early cardiac dysfunction. In this study, we investigated the relation between aortic stiffness and GLS in a large community‐based sample.Methods and ResultsIn 2495 participants (age 39–90 years, 57% women) of the Framingham Offspring and Omni cohorts, free of cardiovascular disease, we performed tonometry to measure arterial hemodynamics and echocardiography to assess cardiac function. Aortic stiffness was evaluated as carotid–femoral pulse wave velocity and as characteristic impedance, and GLS was calculated using speckle tracking–based measurements. In multivariable analyses adjusting for age, sex, height, systolic blood pressure, augmentation index, left ventricular structure, and additional cardiovascular risk factors, increased carotid–femoral pulse wave velocity (B±SE: 0.122±0.030% strain per SD, P<0.0001) and characteristic impedance (0.090±0.029, P=0.002) were both associated with worse GLS. We observed effect modification by sex on the relation between characteristic impedance and GLS (P=0.004); in sex‐stratified multivariable analyses, the relation between greater characteristic impedance and worse GLS persisted in women (0.145±0.039, P=0.0003) but not in men (P=0.73).ConclusionsMultiple measures of increased aortic stiffness were cross‐sectionally associated with worse GLS after adjusting for hemodynamic variables. Parallel reductions in left ventricular long axis shortening and proximal aortic longitudinal strain in individuals with a stiffened proximal aorta, from direct mechanical ventricular‐vascular coupling, offers an alternative explanation for the observed relations.

The role of ventricular–arterial coupling in cardiac disease and heart failure: assessment, clinical implications and therapeutic interventions. A consensus document of the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases, European Association of Cardiovascular Imaging, and Heart Failure Association

“…GLS < 20%) in the presence of normal ejection fraction in patients with hypertension, diabetes, CAD, valvular heart disease and HF . Myocardial deformation markers have been related with myocardial fibrosis, arterial stiffness, natriuretic peptides, exercise capacity, symptoms of HF, and have a prognostic value in valvular heart disease and in HF with reduced and preserved ejection fraction . Thus, these myocardial deformation markers may be surrogate markers of impaired myocardial function.…”

Effects of a Personalized Physical Exercise Program in the Ventricular-arterial Coupling of Older Adults. A Pilot Study

“…The positive modulation provided by physical exercise is in line with previous research, such as the one published by Carrick et al [13], in which the continuous performance of physical exercise throughout life positively influenced VO 2 max, SW, systemic O 2 extraction and VAC in a large cohort. Other researchers [13][14][15][16]34,37] have previously observed similar improvements, initially in animal models with invasive procedures, and later in humans relying on non-invasive methodologies. It is also important to highlight the statistically significant increase observed in Group 2 in the handgrip strength, a recognized marker of frailty in the old adult, and also in the perceived self-efficacy for exercise, which corresponds to an objective indicator of improved self-efficacy capacity for exercise, highlighting not only cardiovascular improvements, but also better overall functional capacity.…”

“…Research on the health benefits of physical exercise, particularly in the elderly, has been a concern of many researchers in recent years [8][9][10][11][12][13][14][15][35][36][37]. This study aimed at studying the effect of physical A B C D exercise on cardiac efficiency in the elderly, using the data obtained in the AGA@4life intervention program [4], which intended to promote active and healthy ageing through a multidisciplinary approach focused on the individual needs, thus aiming to enhance health and well-being.…”

Sex-specific differences in cardiac maladaptation to hypertension and arterial stiffening

“…Also, several measures of aortic stiffening were associated with worse LV longitudinal deformation, even after accounting for important confounders. For instance, in a large Framingham cohort, lower global LS was independently associated with higher aortic pulse wave velocity similarly in both men and women [63].…”