Arterial Wave Reflections and Ventricular-Vascular Interaction in Patients With Left Ventricular Systolic Dysfunction

Abstract

SummaryCentral aortic pressure waveform (AoPW) is the summation of a forward-traveling wave generated by the left ventricle and a backward-traveling wave caused by the reflection of the forward wave. The aim of this study was to evaluate the effect of ventricular-vascular coupling on the morphology of AoPW in chronic heart failure patients with different degrees of left ventricular systolic dysfunction (LVSD) using pulse wave analysis (PWA). PWA of AoPW and left ventricular (LV) function were evaluated by applanation tonometry in 26 control subjects, in 12 patients with left ventricular ejection fraction (LVEF) ≤ 30%, and in 14 patients with LVEF > 30%. Augmentation pressure, augmentation index, wasted energy, and ejection duration were lower in patients with LVEF ≤ 30% than in those with LVEF > 30% and in control subjects. Furthermore, augmentation index showed an inverse correlation with Doppler mitral E-wave amplitude (r = -0.40; P = 0.04) and E/A ratio (r = -0.42; P = 0.03) and a direct correlation with deceleration time of mitral E-waves (r = 0.39; P = 0.04). In patients with severe LVSD (LVEF ≤ 30%), aortic wave reflections negatively interfere with LV function and induce a shortening of ejection duration. In contrast, AoPW is similar in patients with moderate LVSD (LVEF > 30%) and in control subjects. (Int Heart J 2014; 55: 526-532) Key words: Arterial stiffness, Heart failure, Ejection fraction, Pulse pressure H igh brachial pulse pressure (PP), commonly considered a marker of arterial stiffness, has been shown to predict adverse outcomes in patients with left ventricular (LV) systolic dysfunction.1,2) However, in patients with advanced systolic heart failure, the association between PP and outcome is reversed and a low PP is an independent predictor of all cause and cardiovascular death.3,4) It is conceivable that different pathophysiological mechanisms may underlie the opposite prognostic significance of PP in patients with LV systolic dysfunction (LVSD) and different severity of cardiac function impairment.Several sets of data support the greater importance of the central rather than peripheral blood pressure profile in patients with various cardiovascular diseases. A central blood pressure profile offers a more direct measure of LV load and arterial stiffness and provides useful clinical information independently from peripheral PP. [5][6][7][8] The central aortic pressure wave is composed of a forward-traveling wave generated by LV ejection and a late-arriving reflected wave from the periphery. Normally, wave reflections arrive during diastole, when LV has completed the ejection and contribute to coronary perfusion. As arterial stiffness increases, the velocity of forward and reflected waves increases so that the reflected wave arrives earlier to the heart and boosts pressure in late systole with an extra pulsatile workload on the left ventricle.9,10) The availability of noninvasive methods to accurately measure central blood pressure and flow has increased interest in gaining a further understan...

Relation between exercise central haemodynamic response and resting cardiac structure and function in young healthy men

“…We noted disparate associations between resting versus exercise wave reflection intensity and mFS. Previous work has demonstrated an inverse relationship between resting pressure from wave reflections and LV function in older adults and adults with hypertension (Paglia et al ., ). In contrast, we discovered that young individuals with higher pressure from wave reflections at rest demonstrated increased midwall fractional shortening.…”

Enhanced external counterpulsation reduces indices of central blood pressure and myocardial oxygen demand in patients with left ventricular dysfunction

“…Furthermore, significant decreases in APP and LVE w suggest reductions in LV afterload and improved ventricular–vascular coupling after EECP. Indeed, non‐invasive estimates of both APP and LVE w are associated with LVEF in patients with LVD . Importantly, reductions in LV work and myocardial oxygen demand were manifested in concurrent improvement in the Canadian Cardiovascular Society angina functional classification and reduction in anginal symptoms and nitrate usage in patients with moderate LVD after EECP therapy.…”

The Relationships Between the Arterial Stiffness Index Measured at the Radial Artery and Left Ventricular Diastolic Dysfunction in Asymptomatic High Risk Patients Without Atherosclerotic Cardiovascular Disease

“…18) In patients with LV systolic dysfunction, aortic wave reflections and cardio-ankle vascular index negatively interfere with LV function and induce a shortening of EF. 19,20) In a previous study, wave reflection was assessed by wave separation analysis, and was generated predominantly near muscular (medium-sized) and smaller arterial segments. It should be noted that wave reflection is highly modifiable by vasoactive drugs despite small effects on brachial pressure.…”