Indexes of Aortic Pressure Augmentation Markedly Underestimate the Contribution of Reflected Waves Toward Variations in Aortic Pressure and Left Ventricular Mass

Booysen, Hendrik L.; Woodiwiss, Angela J.; Sibiya, Moekanyi J.; Hodson, Bryan; Raymond, Andrew; Libhaber, Elena; Sareli, Pinhas; Norton, Gavin R.

doi:10.1161/hypertensionaha.114.04582

Cited by 48 publications

(28 citation statements)

References 30 publications

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“…22,26,28 Late systolic load from wave reflections has been shown to induce LV hypertrophy and fibrosis in rats. 26 Accordingly, a relationship between reflection magnitude and LV mass measured with cardiac magnetic resonance imaging has been reported in community-based studies, 47,48 and changes in wave reflection magnitude occurring during antihypertensive therapy are associated with the regression of LV mass independently of the reduction in blood pressure. 27 Wave reflection also plays a role in diastolic dysfunction.…”

Section: Effect Of Wave Reflections and Late Systolic LV Load On Lv Rmentioning

confidence: 88%

Ventricular–Arterial Coupling in Chronic Heart Failure

Chirinos¹,

Sweitzer²

2017

Cardiac Failure Review

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PathophysiologyAccess at: www.CFRjournal.comDetailed phenotyping of ventricular-arterial coupling (VAC) and systemic arterial haemodynamics provide important insights into the pathophysiology of left ventricular (LV) energetics, remodelling and fibrosis, and systolic and diastolic dysfunction in various disease states including heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). AbstractMeasures of interaction between the left ventricle (LV) and arterial system (ventricular-arterial coupling) are important but underrecognised cardiovascular phenotypes in heart failure. Ventriculo-arterial coupling is commonly assessed in the pressure-volume plane, using the ratio of effective arterial elastance (E A ) to LV end-systolic elastance (E ES ) to provide information on ventricular-arterial system mechanical efficiency and performance when LV ejection fraction is abnormal. These analyses have significant limitations, such as neglecting systolic loading sequence, and are less informative in heart failure with preserved ejection fraction (HFpEF). E A is almost entirely dependent on vascular resistance and heart rate. Assessment of pulsatile arterial haemodynamics and time-resolved myocardial wall stress provide critical incremental physiological information and should be more widely utilised. Pulsatile arterial load represents a promising therapeutic target in HFpEF. Here, we review various approaches to assess ventricular-arterial interactions, and their pathophysiological and clinical implications in heart failure.

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Section: Effect Of Wave Reflections and Late Systolic LV Load On Lv Rmentioning

confidence: 88%

Ventricular–Arterial Coupling in Chronic Heart Failure

Chirinos¹,

Sweitzer²

2017

Cardiac Failure Review

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“…In agreement with Hashimoto's findings. a relationship between reflection magnitude (approximated from measured pressure and an assumed physiologic flow waveform) and LV mass has been reported in large community-based studies that included normotensive and hypertensive individuals [15, 24]. Similarly, Quail et al recently demonstrated that in patients with repaired aortic coarctation, reflection magnitude assessed from the ascending aortic distension waveform (a surrogate of the aortic pressure waveform) and measured aortic flow (using phase-contrast MRI) was independently associated with LV hypertrophy [25].…”

Section: Arterial Load and The Left Ventricular Loading Sequence: Rolmentioning

confidence: 99%

Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): Clinical and Therapeutic Considerations

Chirinos

2017

J. of Cardiovasc. Trans. Res.

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Multiple phase III trials over the last few decades have failed to demonstrate a clear benefit of various pharmacologic interventions in heart failure with a preserved left ventricular (LV) ejection fraction (HFpEF). Therefore, a better understanding of its pathophysiology is important. An accompanying review describes key technical and physiologic aspects regarding the deep phenotyping of arterial hemodynamics in HFpEF. This review deals with the potential of this approach to enhance our clinical, translational, and therapeutic approach to HFpEF. Specifically, the role of arterial hemodynamics is discussed in relation to (1) the pathophysiology of left ventricular diastolic dysfunction, remodeling, and fibrosis, (2) impaired oxygen delivery to peripheral skeletal muscle, which affects peripheral oxygen extraction, (3) the frequent presence of comorbidities, such as renal failure and dementia in this population, and (4) the potential to enhance precision medicine approaches. A therapeutic approach to target arterial hemodynamic abnormalities that are prevalent in this population (particularly, with inorganic nitrate/nitrite) is also discussed.

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“…The present study design has previously been described. 20,[27][28][29][30] Briefly, families of black African descent (Nguni and Sotho chiefdoms) with siblings older than 16 years of age were randomly recruited from the South West Township (SOWETO) of Johannesburg, South Africa. An age threshold of 16 years was employed to avoid the confounding effects of the rapid age-related increase in BP that occurs in younger individuals.…”

Section: Study Participantsmentioning

confidence: 99%

“…[13][14][15] Therefore, more recently, aortic reflected wave function has been determined from reflected wave pressures (Pb) or the reflected wave index (RI) derived from wave separation analysis. [16][17][18][19][20] In this regard Pb or RI have similarly been demonstrated to predict cardiovascular damage beyond brachial BP. [16][17][18][19][20] As indexes of aortic pressure augmentation [3][4][5][6][7] or wave reflection [16][17][18][19] predict risk beyond brachial BP, the factors that determine these variables are of interest.…”

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confidence: 99%

Intrafamilial Aggregation and Heritability of Aortic Reflected (Backward) Waves Derived From Wave Separation Analysis

Djami-Tchatchou

Norton

Raymond

et al. 2015

American Journal of Hypertension

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Indexes of Aortic Pressure Augmentation Markedly Underestimate the Contribution of Reflected Waves Toward Variations in Aortic Pressure and Left Ventricular Mass

Abstract: Abstract-Although indexes of wave reflection enhance risk prediction, the extent to which measures of aortic systolic pressure augmentation (augmented pressures [Pa]

Cited by 48 publications

References 30 publications

Ventricular–Arterial Coupling in Chronic Heart Failure

Ventricular–Arterial Coupling in Chronic Heart Failure

Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): Clinical and Therapeutic Considerations

Intrafamilial Aggregation and Heritability of Aortic Reflected (Backward) Waves Derived From Wave Separation Analysis

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