Association of Aortic Stiffness With Left Ventricular Remodeling and Reduced Left Ventricular Function Measured by Magnetic Resonance Imaging

Abstract

Background This study sought to assess cross-sectional associations of aortic stiffness assessed by magnetic resonance imaging (MRI) with left ventricular (LV) remodeling and myocardial deformation in the Multi-Ethnic Study of Atherosclerosis (MESA). Methods and Results Aortic arch pulse wave velocity (PWV) was measured with phase contrast cine MRI. LV circumferential strain (Ecc), torsion, and early diastolic strain rate (EDSR) were determined by tagged MRI. Multivariable linear regression models were used to adjust for demographics and cardiovascular risk factors. Of 2093 participants, multivariable linear regression models demonstrated that higher arch PWV was associated with higher LV mass index (B=0.53 per 1 SD increase for log-transformed PWV, p<0.05) and LV mass to volume ratio (LVMVR) (B=0.015, p<0.01), impaired LV ejection fraction (LVEF) (B=−0.84, p<0.001), Ecc (B=0.55, p<0.001), torsion (B=−0.11, p<0.001), and EDSR (B=−0.003, p<0.05). In sex stratified analysis, higher arch PWV was associated with higher MVR (B=0.02, p<0.05), impaired Ecc (B=0.60, p<0.001) and LVEF (B=−0.45, p<0.05), but with maintained torsion in women, whereas higher PWV was associated with impaired Ecc (B=0.49, p<0.001) and LVEF (B=−1.21, p<0.001) with lower torsion (B=−0.17, p<0.001) in men. Conclusions Higher arch PWV is associated with LV remodeling and reduced LV systolic and diastolic function in a large multi-ethnic population. Greater aortic arch stiffness is associated with concentric LV remodeling, relatively preserved LVEF with maintained torsion in women, whereas greater aortic arch stiffness is associated with greater LV dysfunction demonstrated as impaired Ecc, torsion and LVEF with less concentric LV remodeling in men.

Stiff Arteries, Stiff Ventricles

“…17 Endothelial dysfunction is not irreversible, and many emerging nonpharmacological and pharmacological therapeutic strategies are under investigation that aim to reduce oxidative stress and promote nitric oxide release. 18 The observational study of Ohyama et al, 9 taken with other longitudinal data, provides supportive evidence of the role that declining arterial elasticity may have in the development of subclinical impairment of both systolic and diastolic functions.…”

“…17 Endothelial dysfunction is not irreversible, and many emerging nonpharmacological and pharmacological therapeutic strategies are under investigation that aim to reduce oxidative stress and promote nitric oxide release. 18 The observational study of Ohyama et al, 9 taken with other longitudinal data, provides supportive evidence of the role that declining arterial elasticity may have in the development of subclinical impairment of both systolic and diastolic functions.There are many approaches and technologies used to assess vascular stiffness that present both challenges and opportunities for advancing our understanding of hemodynamic factors in heart disease. 1 In the study of Ohyama et al,9 the velocity of the propagating systolic wavefront in the aorta was determined using phase contrast imaging-a noninvasive approach for assessing vascular stiffness that offers good agreement with intra-aortic pressure measurements.…”

“…18 The observational study of Ohyama et al, 9 taken with other longitudinal data, provides supportive evidence of the role that declining arterial elasticity may have in the development of subclinical impairment of both systolic and diastolic functions.…”

“…Age-related changes in proximal aortic stiffness have previously been associated with LV mass and concentricity independent of central blood pressure and conventional cardiovascular risk factors. 10 New data of Ohyama et al 9 indicate that higher aortic arch PWV is also associated with impaired circumferential systolic strain and diastolic function in a community-based population. This study provides further evidence implicating aortic stiffness in adverse cardiac remodeling and impaired myocardial function.…”

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

“…In the Framingham study, exposure to elevated BP at baseline was associated with future development of LVH as assessed by echocardiography in both men and women [21]. Moreover, in line with a small study in 100 subjects free of overt cardiac disease [34], a cross-sectional magnetic resonance imaging study in 2093 MESA participants showed that higher proximal aortic stiffness was associated with LV concentric remodelling [35]. Furthermore, in 607 FLEMENGHO participants, in both men and women, we observed similar associations of longitudinal increases in LV wall thickness and relative wall thickness (a marker of concentric remodelling) with higher baseline PWV during a five-year follow-up period, independent of other important covariables (Fig.…”