Abstract
Background: Coupling between the left ventricle and arterial system can be quantified as the ventricular-arterial coupling (VAC) ratio with 1.00 reflecting optimal physiology. VAC has been most studied in heart failure, with higher values associating with worse prognosis, but its correlates among individuals without heart failure are less characterized. Thus, in the Coronary Artery Risk Development in Young Adults (CARDIA) study we tested the hypothesis that VAC ratio differs by sex and race. Methods: We studied VAC in 2,812 (42% male, 47% black, median age 50 years) CARDIA year 25 exam participants with transthoracic echocardiogram data available and no history of heart failure, myocardial infarction, peripheral vascular disease, or valvular disease. VAC was calculated as arterial elastance (Ea) divided by LV end systolic elastance (Ees). Ea and Ees were calculated as end systolic pressure/stroke volume and by the modified Chen single beat method, respectively. Associations between sex and race with VAC were tested in multivariable-adjusted linear regression. Results: VAC ratio differed by both sex and race with higher unadjusted values in men (median 1.14 [25 th -75 th percentile 1.08-1.20]) compared with women (1.11 [1.05-1.17]), p < 0.001, and white (1.12 [1.07-1.18]) compared with black (1.11 [1.06-1.18]) individuals, p = 0.004. In adjusted models, male sex (beta 0.027 [95% CI 0.021 to 0.037], p <0.001) and white race (0.007 [0.002 to 0.012], p = 0.009) remained associated with higher VAC ratio (Figure 1). Sex, LV ejection fraction (beta -0.096 [95% CI -0.099 to -0.093], and total arterial compliance (-0.045 [-0.049 to -0.041]) were the most strongly associated correlates of VAC. Systolic blood pressure, creatinine, heart rate, LDL, and triglycerides inversely associated with VAC. Age and LV remodeling index positively associated with VAC. Conclusions: In community dwelling middle-aged adults, male sex and white race independently associated with higher VAC.
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