Abstract
ObjectiveData regarding the influence of arterial stiffness on myocardial work (MW) has been scarce. This study was performed to investigate the association between brachial-ankle pulse wave velocity (baPWV) and MW by non-invasive left ventricular pressure–strain in a population of non-hypertensive and hypertensive individuals.MethodsTwo hundred and eight participants (104 hypertensive and 104 non-hypertensive individuals) were prospectively enrolled into the study. All participants underwent conventional echocardiography, as well as 2D speckle-tracking echocardiography to assess MW by non-invasive left ventricular pressure–strain and global longitudinal strain (GLS). baPWV measurements were made at the same day as the echocardiography. Then, participants were categorized according to baPWV tertiles. Correlation between baPWV and MW were analyzed. Predicting ability of baPWV for abnormal WM was analyzed using receiver operating characteristic (ROC) curve.ResultsThe median baPWV from the low to high tertile groups were 1286.5 (1197.5–1343.5), 1490.0 (1444.5–1544.0), and 1803.8(1708.3–1972.0) cm/s, respectively. In simple linear regression analysis, baPWV had a significant positive association with global work index (GWI), global constructed work (GCW), and global wasted work (GWW), and a negative association with global work efficiency (GWE). The association remained significant after adjusting for major confounding factors in multiple linear regression analysis. The areas under the ROC curve of baPWV for predicting abnormal GWI, GCW, GWW, and GWE were 0.653, 0.666, 0.725, and 0.688, respectively (all p < 0.05).ConclusionsBaPWV is significantly associated with all four components of MW using non-invasive left ventricular pressure-strain method in a mixed population of non-hypertensive and hypertensive individuals.
Highlights
An accurate and very early identification of the impairment in left ventricular contractility is pivotal in terms of prognosis in a majority of cardiac disease [1]
Chan et al showed that myocardial work (MW) assessment was beneficial for hypertensive patients, as MW index showed an increase in acute pressure overload, while EF and left ventricular global longitudinal strain (LVGLS) remained unaffected [7]
The study populations were categorized into tertiles according to the brachial-ankle pulse wave velocity (baPWV)
Summary
An accurate and very early identification of the impairment in left ventricular contractility is pivotal in terms of prognosis in a majority of cardiac disease [1]. Left ventricular global longitudinal strain (LVGLS), assessed by speckle-tracking echocardiography, is increasingly utilized to evaluate even sub-clinical alterations in left ventricular (LV) function where LVEF is normal [2, 3]. Speaking, myocardial work (MW) is a reliable index for assessment of myocardial function as it reflects the myocardial O2-metabolism It is never implemented in clinical routine, because it is traditionally evaluated by an invasive pressure-volume loop [5]. According to a similar principle, Russell et al assessed segmental and global MW by measuring LV pressure-strain loop (LV-PSL), a non-invasive method (brachial artery cuff pressure) [6] As it took into account deformation as well as afterload, the MW by non-invasive LV-PSL potentially offered more incremental value than strain and LVEF to myocardial function assessment. Chan et al showed that MW assessment was beneficial for hypertensive patients, as MW index showed an increase in acute pressure overload, while EF and LVGLS remained unaffected [7]
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