Negative Impact of Cardiovascular Risk Factors on Left Atrial and Left Ventricular Function Related to Aortic Stiffness

Oishi, Yoshifumi; Miyoshi, Hirokazu; Iuchi, Arata; Nagase, Norio; Ara, Nusrat; Oki, Takashi

doi:10.1253/circj.cj-12-1260

Cited by 22 publications

(27 citation statements)

References 33 publications

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“…19) In the present study, multivariate regression analysis identifi ed age, BMI, SBP, and LV systolic parameters (end-systolic diameter, LVEF, s', and peak systolic radial strain) as independent predictors of LA diastolic stiffness in the comorbid group. Recent studies have demonstrated that subendocardial LA and LV layers along the longitudinal direction and intima and media of large arteries are first and simultaneously impaired by physiologic aging and by CVR factors through various mechanisms, 6,8) and subsequently, a combination of CVR factors leads to a signifi cant and additive negative impact on LA diastolic stiffness related to LV dysfunction and arterial stiffening.…”

Section: Discussionmentioning

confidence: 59%

“…6,19) The new angle-independent 2-dimensional speckle-tracking echocardiography (2DSTE) permits the evaluation of not only LA and LV myocardial deformation [6][7][8][9] but also aortic and carotid arterial circumferential deformation. 17,19) This new mo- Values are mean ± standard deviation. § P < 0.05, § § P < 0.01, comparison with control group, * P < 0.05, ** P < 0.01, comparison with 1 risk factor group.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies have demonstrated that subendocardial LA and LV layers along the longitudinal direction and intima and media of large arteries are first and simultaneously impaired by physiologic aging and by CVR factors through various mechanisms, 6,8) and subsequently, a combination of CVR factors leads to a signifi cant and additive negative impact on LA diastolic stiffness related to LV dysfunction and arterial stiffening. 15,19) Therefore, inappropriate increases in the number of CVR factors seem to cause more deteriorated LA-LV-arterial interaction, and may predispose the patient to HFPEF. Study limitations: First of all, the principal limitation was the comparatively small number of patients available for analysis.…”

Section: Discussionmentioning

confidence: 99%

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Influence of Comorbid Cardiovascular Risk Factors on Left Atrial-Left Ventricular Interaction in Asymptomatic Patients

et al. 2014

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SummaryPrevious studies have examined the negative impacts of individual cardiovascular risk (CVR) factors on left atrial (LA)-left ventricular (LV) interaction, whereas the combined effects of these risk factors are insuffi ciently elucidated. We studied 176 asymptomatic patients with CVR factors and age-matched 50 healthy individuals by conventional and 2-dimensional speckle-tracking echocardiography. The patients were classifi ed into 2 groups according to the number of CVR factors: one risk factor (single) group (n = 79) and 2 or more risk factors (comorbid) group (n = 97). The peak early diastolic transmitral fl ow velocity (E)/peak early diastolic mitral annular motion velocity (e')/peak systolic LA strain (SLAs) was used as a surrogate for LA stiffness during ventricular systole. The E/e'/S-LAs was greatest in the comorbid group. The peak systolic LV circumferential and radial strains, peak early diastolic LV radial strain rate, and peak early diastolic LA strain and strain rate were lower in the comorbid group than in the single group. Multivariate regression analysis identifi ed age, body mass index, systolic blood pressure, end-systolic LV diameter, peak systolic mitral annular motion velocity (s'), and peak systolic LV radial strain in the comorbid group, and peak atrial systolic transmitral fl ow velocity and s' in the single group, as independent predictors of E/e'/S-LAs. Subtle LA and LV dysfunction with individual CVR factors were more aggravated with the comorbid conditions in asymptomatic patients. (Int Heart J 2014; 55: 138-145) Key words: LA diastolic stiffness, LA-LV interaction, 2-D speckle-tracking echocardiography I t is now recognized that approximately one-half of patients with the clinical syndrome of congestive heart failure (HF) have preserved systolic function, a condition referred to as HF with preserved ejection fraction (HFPEF). 1,2)The prevalence of this disease condition is anticipated to increase in elderly patients with cardiovascular risk (CVR) factors such as hypertension, diabetes, dyslipidemia, obesity, and smoking.2,3) Therefore, it is expected that a higher comorbid burden of the CVR factors is an important contributor to the development of HFPEF. Assessment of left atrial (LA) and left ventricular (LV) function, which we named as LA-LV interaction, 4) seems to have a clinical impact, because an abnormal LA-LV interaction is a mechanism responsible for producing congestion symptom. 4,5) However, few data are available on use and outcome studied with conventional echocardiography in the evaluation of LA-LV interaction in asymptomatic patients in the community. Angle-independent two-dimensional speckle-tracking echocardiography (2DSTE) has recently been introduced into clinical practice because it offers early detection of impaired LA reservoir function 6,7) and LV contraction and relaxation 8,9) in subclinical patients with CVR factors. We hypothesized that comorbid conditions of CVR factors would be associated with worse LA-LV interaction, probably providing a potent...

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Influence of Comorbid Cardiovascular Risk Factors on Left Atrial-Left Ventricular Interaction in Asymptomatic Patients

et al. 2014

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“…The most common causes of HFpEF are old age, HTN, and cardiac ischaemia but other diseases can also lead to HFpEF [5]. Heart stiffening and decreased filling result in decreased ability of the heart to pump blood to the body [6].…”

Section: Introductionmentioning

confidence: 99%

“…The functional interaction between the LV and arterial tree, termed ventriculararterial coupling, is recognized as a key determinant of cardiovascular performance [10][11][12][13][14]. This arterio-myocardial coupling decline is further precipitated by the presence of other CVD risk factors leading to the development of HFpEF [5,14,15].…”

Section: Introductionmentioning

confidence: 99%

Stiff Heart and Stiff Arteries. Could We Soften Both?

Athyros¹,

Τζιόμαλος²,

Farganis³

et al. 2013

TOHYPERJ

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Abstract:Old age, female gender, hypertension (HTN), cardiac ischaemia, and arterial stiffness (AS) are the main determinants of a stiff heart, diastolic dysfunction (DD), and finally heart failure with preserved ejection fraction (HFpEF); however, several cardiac or extra-cardiac pathologies may also be involved. The combined ventricular-arterial stiffening (abnormal left ventricle-arterial coupling) is the main determinant of the increased prevalence of HFpEF in elderly persons, particularly women, and in younger subjects with HTN. Hospitalization and mortality rates in patients with HFpEF are similar to those of patients with heart failure with reduced EF (HFrEF). However, although the prognosis of HFrEF has improved over time, the optimal treatment of HFpEF remains unclear, because of the differences in the pathophysiology of the two syndromes. A number of new drugs have shown promise but they will not be commercially available for several years. For the time being, aggressive treatment of non-cardiac comorbidities is the only option available for the management of HFpEF. Treatment of anaemia, sleep disorders, chronic kidney disease, non-alcoholic fatty liver disease, atrial fibrillation, diabetes mellitus, and judicious use of diuretics are effective to some degree. Statin treatment deserves special attention, regardless of the presence of dyslipidaemia, because it has been shown, mainly in small studies, post hoc analyses, and in a large recent meta-analysis, that it is related to an improved quality of life and a reduction in HF-related mortality. We urgently need to utilize these recourses to relieve a substantial number of patients suffering from HFpEF, a disease with an ominous prognosis.

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Aortic thoracic neuromodulation in heart failure with preserved ejection fraction

Paolisso

Dagan²,

Gallinoro

et al. 2022

ESC Heart Failure

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The inadequacy of medical therapies for heart failure with preserved ejection fraction (HFpEF) is driving the development of device‐based solutions targeting underlying pathophysiologic abnormalities. The maladaptive autonomic imbalance with a reduction in vagal parasympathetic activity and increased sympathetic signalling contributes to the deterioration of cardiac performance, patient fitness, and the increased overall morbidity and mortality. Thoracic aortic vagal afferents mediate parasympathetic signalling, and their stimulation has been postulated to restore autonomic balance. In this first‐in‐man experience with chronic stimulation of aortic vagal afferents (Harmony™ System, Enopace, Israel), we demonstrate improved left atrial remodelling and function parallel with improved left ventricular performance. The observed favourable structural and functional cardiac changes remained stable throughout the 1 year follow‐up and were associated with improved symptoms and physical fitness. The current experience warrants further validation of the endovascular stimulation of aortic thoracic afferents as a new interventional approach for device‐based treatment in HFpEF.

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Negative Impact of Cardiovascular Risk Factors on Left Atrial and Left Ventricular Function Related to Aortic Stiffness

Cited by 22 publications

References 33 publications

Influence of Comorbid Cardiovascular Risk Factors on Left Atrial-Left Ventricular Interaction in Asymptomatic Patients

Influence of Comorbid Cardiovascular Risk Factors on Left Atrial-Left Ventricular Interaction in Asymptomatic Patients

Stiff Heart and Stiff Arteries. Could We Soften Both?

Aortic thoracic neuromodulation in heart failure with preserved ejection fraction

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