Interaction between pulse wave velocity, augmentation index, pulse pressure and left ventricular function in chronic heart failure

Abstract

Pulse wave velocity (PWV), the carotid augmentation index (AIx), and pulse pressure (PP) may be prognostic factors in heart failure, but the possible influence of the ejection fraction (EF) and other simple haemodynamic variables on them has not been investigated in this setting. Noninvasive methods were used to measure carotid-radial (CR), carotid-femoral (CF) PWV and AIx, and brachial PP, in 135 consecutive patients with stable symptomatic chronic heart failure. The patients were divided into two groups, with preserved (X40%) or reduced (o40%) EF. CF-PWV, AIx and PP were lower in the decreased EF group (8.8572.77 versus 10.6072.75 m/s, Po0.001; 121721 versus 132724, P ¼ 0.009 and 41719 versus 67717 mmHg, Po0.001), but CR-PWV values were similar regardless of the EF status. These results were not modified after adjustment for age and sex. Multiple regression analysis showed that AIx and PP were systematically related to time domain parameters (heart rate or ejection duration) and EF, whatever the group. CF-PWV was weakly related to time domain values and unrelated to mean blood pressure (BP) or EF in the preserved EF group, whereas it was related to both mean BP and EF in the low EF group. In conclusion, whatever the EF level, PP and AIx were strongly modulated in the time domain, by pressure and by the EF level. The same relationships were found with CF-PWV, but only in the reduced EF group. Whether CF-PWV is the best prognostic factor in patients with 'diastolic' heart failure must be confirmed in a prospective study.

Pulse Wave Analysis of the Aortic Pressure Waveform in Severe Left Ventricular Systolic Dysfunction

“…However, in contrast to those results, we found an increase in Tr of the pressure wave, indicating a decrease in PWV, and an increase in pulse pressure amplification, which together imply a decrease in arterial stiffness and is consistent with the measured decrease in augmented pressure and AI a . Our results are supported by the results of Tartière et al, 33 which involved patients with a similar EF (mean LVEF 24Ϯ9% among study patients with reduced EF) and which showed a decrease in the effects of wave reflection on AoPW. These pressure changes result from altered ventricular/vascular coupling.…”

“…Only one previous study reported a decrease in arterial stiffness and PWV similar to our findings; this was the study by Tartière et al, 33 performed in patients with severe LVSD and reduced mean arterial pressure. Because the activities of the LV and peripheral arterial system are interactive (ventricular/vascular coupling), the decrease in arterial stiffness and PWV may be the result of a decrease in mean arterial pressure in response to reduced cardiac output and LV afterload.…”

“…30 -32 These studies, however, only measured the extremes in brachial blood pressure (ie, bPPϭbSPϪbDP), whereas in our study, the central AoPW, a more accurate indicator of LV afterload and adverse outcome, was measured. Several other studies have measured central AoPW, but most of those studies were performed in patients with mild-to-moderate LVSD (LVEF 30% to Ͼ40%), 20,22,23,[33][34][35] whereas our study was performed primarily in patients with severe LVSD (21 of 25). Most of the earlier studies found no change in aortic PWV and travel time of the pressure wave to and from the periphery.…”

A Randomized Pilot Study of Aortic Waveform Guided Therapy in Chronic Heart Failure

“…Prior studies have shown that mean AIx in HFrEF patients is 21%, 18 and that AIx is reduced (in absolute units) by 8% with enalapril, 12 20% with nitrates, 13 and 9% with spironolactone. 14 The goal in the active treatment arm was to reduce AIx to 0%.…”

Arterial stiffness: beyond pulse wave velocity and its measurement

“…7 The epidemiology, 8 genetic associations 9 and prognostic implications 10 of PWV (and arterial stiffness) have also been reported as has the relationship to haemodynamics, 11 cardiac structure and function. 12,13 Thus, it is increasingly important to have accurate and reproducible methods to assess PWV. In this issue of the Journal of Human Hypertension, Salvi and co-workers 14 demonstrate the reproducibility and reliability of PWV measured by three frequently used devices: the Complior and the PulsePen, both of which determine aortic PWV as the delay between carotid and femoral pressure wave, and the PulseTrace, which estimates the Stiffness Index by analysing photoplethysmographic waves acquired on the fingertip.…”