Relations of Central Hemodynamics and Aortic Stiffness with Left Ventricular Structure and Function: The Framingham Heart Study

Kaess, Bernhard M.; Rong, Jian; Larson, Martin G.; Hamburg, Naomi M.; Vita, Joseph A.; Cheng, Susan; Aragam, Jayashree; Levy, Daniel; Benjamin, Emelia J.; Vasan, Ramachandran S.; Mitchell, Gary F.

doi:10.1161/jaha.115.002693

Cited by 94 publications

(82 citation statements)

References 35 publications

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“…CFPWV was associated with GLS and not GCS, which may indicate that long‐axis function of the LV is more closely linked with global aortic wall stiffness than is short‐axis function. In prior work conducted in this study sample, we have observed that CFPWV is significantly associated with measures of LV diastolic function but not with conventional measures of LV systolic function 48. In light of these prior results, the lack of association of CFPWV with circumferential strain is consistent with the concept that mechanical (ie, non‐hemodynamic) coupling is selectively related to LV function in the long axis.…”

Section: Discussionsupporting

confidence: 77%

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

Bell

McCabe

Larson

et al. 2017

JAHA

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BackgroundAortic stiffness impairs optimal ventricular–vascular coupling and left ventricular systolic function, particularly in the long axis. Left ventricular global longitudinal strain (GLS) has recently emerged as a sensitive measure of early cardiac dysfunction. In this study, we investigated the relation between aortic stiffness and GLS in a large community‐based sample.Methods and ResultsIn 2495 participants (age 39–90 years, 57% women) of the Framingham Offspring and Omni cohorts, free of cardiovascular disease, we performed tonometry to measure arterial hemodynamics and echocardiography to assess cardiac function. Aortic stiffness was evaluated as carotid–femoral pulse wave velocity and as characteristic impedance, and GLS was calculated using speckle tracking–based measurements. In multivariable analyses adjusting for age, sex, height, systolic blood pressure, augmentation index, left ventricular structure, and additional cardiovascular risk factors, increased carotid–femoral pulse wave velocity (B±SE: 0.122±0.030% strain per SD, P<0.0001) and characteristic impedance (0.090±0.029, P=0.002) were both associated with worse GLS. We observed effect modification by sex on the relation between characteristic impedance and GLS (P=0.004); in sex‐stratified multivariable analyses, the relation between greater characteristic impedance and worse GLS persisted in women (0.145±0.039, P=0.0003) but not in men (P=0.73).ConclusionsMultiple measures of increased aortic stiffness were cross‐sectionally associated with worse GLS after adjusting for hemodynamic variables. Parallel reductions in left ventricular long axis shortening and proximal aortic longitudinal strain in individuals with a stiffened proximal aorta, from direct mechanical ventricular‐vascular coupling, offers an alternative explanation for the observed relations.

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Section: Discussionsupporting

confidence: 77%

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

Bell

McCabe

Larson

et al. 2017

JAHA

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“…The ratio of early transmitral flow velocity (E) and early systolic mitral annulus velocity (e′) was used as an indicator of LV diastolic function. The reproducibility of echocardiographic measurements at FHS has been previously reported 34, 35…”

Section: Methodsmentioning

confidence: 84%

“…E′ was measured using tissue Doppler imaging at the lateral mitral annulus and E was measured using transmitral Doppler flow velocities 34. The ratio of early transmitral flow velocity (E) and early systolic mitral annulus velocity (e′) was used as an indicator of LV diastolic function.…”

Section: Methodsmentioning

confidence: 99%

Association of Circulating Adipokines With Echocardiographic Measures of Cardiac Structure and Function in a Community‐Based Cohort

Jeinsen

Short

Xanthakis

et al. 2018

JAHA

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BackgroundAdipokines mediate cardiometabolic risk associated with obesity but their role in the pathogenesis of obesity‐associated heart failure remains uncertain. We investigated the associations between circulating adipokine concentrations and echocardiographic measures in a community‐based sample.Methods and ResultsWe evaluated 3514 Framingham Heart Study participants (mean age 40 years, 53.8% women) who underwent routine echocardiography and had select circulating adipokines measured, ie, leptin, soluble leptin receptor, fatty acid–binding protein 4, retinol‐binding protein 4, fetuin‐A, and adiponectin. We used multivariable linear regression, adjusting for known correlates (including weight), to relate adipokine concentrations (independent variables) to the following echocardiographic measures (dependent variables): left ventricular mass index, left atrial diameter in end systole, fractional shortening, and E/e′. In multivariable‐adjusted analysis, left ventricular mass index was inversely related to circulating leptin and fatty acid–binding protein 4 concentrations but positively related to retinol‐binding protein 4 and leptin receptor levels (P≤0.002 for all). Left atrial end‐systolic dimension was inversely related to leptin but positively related to retinol‐binding protein 4 concentrations (P≤0.0001). E/e′ was inversely related to leptin receptor levels (P=0.0002). We observed effect modification by body weight for select associations (leptin receptor and fatty acid–binding protein 4 with left ventricular mass index, and leptin with left atrial diameter in end systole; P<0.05 for interactions). Fractional shortening was not associated with any of the adipokines. No echocardiographic trait was associated with fetuin‐A or adiponectin concentrations.ConclusionsIn our cross‐sectional study of a large, young to middle‐aged, relatively healthy community‐based sample, key indices of subclinical cardiac remodeling were associated with higher or lower circulating concentrations of prohypertrophic and antihypertrophic adipokines in a context‐specific manner. These observations may offer insights into the pathogenesis of the cardiomyopathy of obesity.

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“…A recent large study of 5799 participants (Framingham Heart Study) also showed significant correlations of cfPWV and central pulse pressure with lateral e′ velocity and E/e′. [8] Borlaug et al [23] performed noninvasive measurement using applanation tonometry in 58 participants, and showed that carotid augementation index and carotid characteristic impedence have an independent association with LV septal e′ velocity. Similarly, our results showed that arterial stiffness measured by baPWV was signficantly correlated with septal e′ velocity and E/e′ in univariate anslyses.…”

Section: Discussionmentioning

confidence: 99%

Association between arterial stiffness and left ventricular diastolic function in relation to gender and age

et al. 2017

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Left ventricular (LV) diastolic dysfunction and subsequent overt heart failure are more prevalent in elderly women. Close interaction between arterial stiffness and LV morphology/function has been reported. The aim of this study was to investigate whether there is an age- and gender-dependent relationship between arterial stiffness and LV diastolic function. A total of 819 subjects (58.6 ± 13.3 years, 50.2% men) without structural heart disease (LV ejection fraction ≥50%) were retrospectively analyzed. All participants underwent transthoracic echocardiography and brachial-ankle pulse wave velocity (baPWV) measurement on the same day. The association of baPWV with septal e′ velocity and average E/e′ was assessed. In the total study subjects, baPWV was negatively correlated with septal e′ velocity (r = 0.383, P < 0.001), and positively correlated with E/e′ (r = −0.266, P < 0.001). These linear correlations remained significant even after stratificaion of the study subjects by age (<65 years vs ≥65 years) and genders (P < 0.05 for each). There were obvious differences in baPWV according to groups with normal LV diastolic function, intermediate profile and LV diastolic dysfunction in young (P = 0.010) and elderly (≥65 years) women (P < 0.001) and eldery men (P = 0.012) but not in elderly men (P = 0.270). There was a significant association of baPWV with septal e′ velocity (β = −0.258, P = 0.020) and E/e′ (β = 0.122, P = 0.030) in elderly women even after controlling for multiple clinical covariates. This independent association was not seen in younger women and men (P > 0.05 for each). In conclusion, baPWV was independently associated with septal e′ velocity and E/e′ in elderly women but not in younger women or men. The results of this study provide additional evidence that increased arterial stiffness plays an important role in the development of heart failure with preserved ejection fraction as well as LV diastolic dysfunction in elderly women.

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Relations of Central Hemodynamics and Aortic Stiffness with Left Ventricular Structure and Function: The Framingham Heart Study

Abstract: Background--The differing relations of steady and pulsatile components of central hemodynamics and aortic stiffness with cardiac dimensions and function have not been fully elucidated.

Cited by 94 publications

References 35 publications

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

Relations Between Aortic Stiffness and Left Ventricular Mechanical Function in the Community

Association of Circulating Adipokines With Echocardiographic Measures of Cardiac Structure and Function in a Community‐Based Cohort

Association between arterial stiffness and left ventricular diastolic function in relation to gender and age

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