Abstract
ObjectivesIncreased arterial stiffness is associated with left ventricular diastolic dysfunction (LVDD), but this association may be influenced by left ventricular (LV) performance. Left ventricular hypertrophy (LVH) is not only a significant determinant of LV performance, but is also correlated with LVDD. This study is designed to compare LV diastolic function among patients divided by brachial-ankle pulse wave velocity (baPWV) and electrocardiography (ECG)-determined LVH and to assess whether increased baPWV and ECG-determined LVH are independently associated with LVDD.MethodsThis cross-sectional study enrolled 270 patients and classified them into four groups according to the median value of baPWV and with/without ECG-determined LVH. The baPWV was measured using an ABI-form device. ECG-determined LVH was defined by Sokolow-Lyon criterion. LVDD was defined as impaired relaxation, pseudonormal, and restrictive mitral inflow patterns. Groups 1, 2, 3, and 4 were patients with lower baPWV and without ECG-determined LVH, lower baPWV but with ECG-determined LVH, higher baPWV but without ECG-determined LVH, and higher baPWV and with ECG-determined LVH respectively.ResultsEarly diastolic mitral velocity (Ea) was gradually decreased from group 1 to group 4 (p≦0.027). Patients in group 4 had the highest prevalence of LVDD (all p<0.001). After multivariate analysis, both baPWV and ECG-determined LVH were independent determinants of Ea (β = −0.02, P<0.001; β = −1.77, P<0.001 respectively) and LVDD (odds ratio = 1.02, P = 0.011 and odds ratio = 3.53, P = 0.013 respectively).ConclusionOur study showed the group with higher baPWV and ECG-determined LVH had the lowest Ea and highest prevalence of LVDD. In addition, both baPWV and ECG-determined LVH were independently associated with Ea and LVDD. Hence, assessment of arterial stiffness by baPWV and LVH by ECG may be useful in identifying the high risk group of LVDD.
Highlights
Increased pulse wave velocity (PWV), which reflects increased arterial stiffness, may result in left ventricular (LV) remodeling and thereby cause left ventricular diastolic dysfunction (LVDD) [1,2]
The aims of this study are to compare the LV diastolic function among patients divided by the median value of brachial-ankle PWV (baPWV) and with/without ECG-determined Left ventricular hypertrophy (LVH) and to assess whether the increased baPWV and 12-lead ECG-determined LVH are independently associated with LVDD
History of diabetes, hypertension, and coronary artery disease, wide pulse pressure, increased heart rate, increased baPWV, ECG-determined LVH, high fasting glucose, angiotensin converting enzyme inhibitors (ACEIs) use, angiotensin II receptor blockers (ARBs) use, diuretic use, and nitrate use were significantly associated with low Early diastolic mitral velocity (Ea) in the univariate analysis
Summary
Increased pulse wave velocity (PWV), which reflects increased arterial stiffness, may result in left ventricular (LV) remodeling and thereby cause left ventricular diastolic dysfunction (LVDD) [1,2]. Several previous studies have reported a relation between arterial stiffness and LV diastolic function [5,6,7]. LVH may have a significant influence on the relationship between PWV and LV diastolic function. Villari BM et al stated that the prolongation of relaxation was closely related to the magnitude of hypertrophy in patients with aortic stenosis and regurgitation [12]. Hess OM et al reported that the most common cause for LVDD is LVH in patients with aortic stenosis [13]. These studies all revealed that there was a close association between LVH and LVDD
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