Echocardiographic Assessment of Aortic Pulse Wave Velocity as a New Diagnostic Parameter for Left Ventricular Diastolic Dysfunction

Abstract

Abstract Background The association between increased arterial stiffness and Left ventricular (LV) diastolic dysfunction (DD) has been well characterized, suggesting a close interaction between the arterial system and the left ventricle. Aortic pulse-wave velocity (PWV) is a measure of aortic stiffness, and it has an established prognostic role in cardiovascular diseases and in the general population. Aim Evaluation of aortic PWV assessed by echocardiography as a new diagnostic parameter for LV DD by correlation with current echocardiographic LV DD indices, and also evaluation of aortic PWV prognostic value in patients with DD by correlation with Brain natriuretic peptide (BNP). Methods This study was conducted at Ain-Shams and Helwan University hospitals from December 2017 to December 2018. It included 100 subjects aged from 55 to 60 years; they were divided into two groups, 1st group (case group): 80 patients with asymptomatic LV DD with preserved ejection fraction ≥50%, 2nd group (control group): 20 patients with normal diastolic function. All patients were subjected to full history and thorough physical examination. BNP, ECG and full echocardiography with assessment of aortic PWV were done. Results A total of 100 patients were enrolled, 38 (47.5%) males in case group vs. 9 (45%) in control group. Hypertension, diabetes and dyslipidemia were significantly higher in case vs. control (P-values: <0.001, 0.005, 0.002 respectively). Aortic PWV has significant positive correlation with both age and body mass index (r = 0.422, r = 0.847 respectively with P < 0.001 for both). Aortic PWV has significant positive correlation with E/e’ (r = 0.957, P < 0.001), tricuspid regurge velocity (r = 0.941, P < 0.001), and left atrial volume index (r = 0.947, P < 0.001), but it has significant negative correlation with septal e’ (r=-0.970, P < 0.001) and lateral e’ (r=-0.932, P < 0.001). Aortic PWV has significant positive correlation with plasma BNP level (r = 0.958, P < 0.001). Aortic PWV was significantly higher in case vs. control group with mean values (15.5±1.32 vs. 10.11±0.78 m/s respectively; P < 0.001). The area under the ROC curve for aortic PWV to detect DD was 0.86 (95% CI, 0.76–0.98; P < 0.001) and the optimal cutoff point of 12.5 m/s produced 92.3% sensitivity and 75.0% specificity (the positive and negative predictive values were 93.5 and 72.7%, respectively with an accuracy of 89.0%). Conclusion Echocardiographic assessment of aortic PWV appears not only to be a highly sensitive, reliable, easy, rapid and practical parameter for LV DD detection but also has a promising prognostic value in patients with LV DD.