Abstract
BackgroundPrevious studies highlighted the usefulness of integrating left ventricular (LV) deformation (strain) and hemodynamic parameters to quantify LV performance. In a population sample, we investigated the anthropometric and clinical determinants of a novel non-invasive index of LV systolic performance derived from simultaneous registration of LV strain and brachial pressure waveforms.MethodsThree hundred fifty-six randomly recruited subjects (44.7% women; mean age, 53.9 years; 47.5% hypertensive) underwent echocardiographic and arterial data acquisition. We constructed pressure-strain loops from simultaneously recorded two-dimensional LV strain curves and brachial pressure waveforms obtained by finger applanation tonometry. We defined the area of this pressure-strain loop during ejection as LV ejection work density (EWD). We reported effect sizes as EWD changes associated with a 1-SD increase in covariables.ResultsIn multivariable-adjusted analyses, higher EWD was associated with age, female sex and presence of hypertension (P ≤ 0.0084). In both men and women, EWD increased independently with augmentation pressure (effect size: + 59.1 Pa), central pulse pressure (+ 65.7 Pa) and pulse wave velocity (+ 44.8 Pa; P ≤ 0.0006). In men, EWD decreased with relative wall thickness (− 29.9 Pa) and increased with LV ejection fraction (+ 23.9 Pa; P ≤ 0.040). In women, EWD increased with left atrial (+ 76.2 Pa) and LV end-diastolic (+ 43.8 Pa) volume indexes and with E/e’ ratio (+ 51.1 Pa; P ≤ 0.026).ConclusionOlder age, female sex and hypertension were associated with higher EWD. Integration of the LV pressure-strain loop during ejection might be a useful tool to non-invasively evaluate sex-specific and interdependent effects of preload and afterload on LV myocardial performance.
Highlights
Previous studies highlighted the usefulness of integrating left ventricular (LV) deformation and hemodynamic parameters to quantify LV performance
Cauwenberghs et al Cardiovascular Ultrasound (2019) 17:15 older women appear susceptible to the detrimental effects of increased pulsatile load on LV diastolic function [4, 6, 7], which might be explained by the higher aortic stiffness, enhanced LV systolic performance, higher preload sensitivity and lower LV compliance in women as in men [9]
We explored the relationship of ejection work density (EWD) with indexes reflecting LV structure, LV diastolic function and arterial stiffness
Summary
Previous studies highlighted the usefulness of integrating left ventricular (LV) deformation (strain) and hemodynamic parameters to quantify LV performance. Cauwenberghs et al Cardiovascular Ultrasound (2019) 17:15 older women appear susceptible to the detrimental effects of increased pulsatile load on LV diastolic function [4, 6, 7], which might be explained by the higher aortic stiffness, enhanced LV systolic performance, higher preload sensitivity and lower LV compliance in women as in men [9]. Echocardiographic techniques such as two-dimensional (2D) speckle tracking allow quantification of the relative myocardial deformation (i.e. strain) [10]. We previously constructed LV pressure-strain loops from simultaneously recorded LV strain curves and carotid pressure waveforms, and defined the area of these loops during ejection as the LV ejection work density (EWD) [2]
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