Elsevier

JACC: Cardiovascular Imaging

Volume 15, Issue 9, September 2022, Pages 1545-1559
JACC: Cardiovascular Imaging

Original Research
Ventricular-Arterial Coupling Derived From Proximal Aortic Stiffness and Aerobic Capacity Across the Heart Failure Spectrum

https://doi.org/10.1016/j.jcmg.2022.03.024Get rights and content
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Abstract

Background

Ventricular-arterial coupling (VAC) can be evaluated as the ratio between arterial stiffness (pulsed wave velocity [PWV]) and myocardial deformation (global longitudinal strain [GLS]).

Objectives

This study aimed to evaluate VAC across the spectrum of heart failure (HF).

Methods

The authors introduced a Doppler-derived, single-beat technique to estimate aortic arch PWV (aa-PWV) in addition to tonometry-derived carotid-femoral PWV (cf-PWV). They measured PWVs and GLS in 155 healthy controls, 75 subjects at risk of developing HF (American College of Cardiology/American Heart Association stage A-B) and 236 patients in stage C heart failure with preserved ejection fraction (HFpEF) (n = 104) or heart failure with reduced ejection fraction (HFrEF) (n = 132). They evaluated peak oxygen consumption and peripheral extraction using combined cardiopulmonary-echocardiography exercise stress.

Results

aa-PWV was obtainable in all subjects and significantly lower than cf-PWV in all subgroups (P < 0.01). PWVs were directly related and increased with age (all P < 0.0001). cf-PWV/GLS was similarly compromised in HFrEF (1.09 ± 0.35) and HFpEF (1.05 ± 0.21), whereas aa-PWV/GLS was more impaired in HFpEF (0.70 ± 0.10) than HFrEF (0.61 ± 0.14; P < 0.01). Stage A-B had values of cf-PWV/GLS and aa-PWV/GLS (0.67 ± 0.27 and 0.48 ± 0.14, respectively) higher than controls (0.46 ± 0.11 and 0.39 ± 0.10, respectively) but lower than stage C (all P < 0.01). Peak arteriovenous oxygen difference (AVO2diff) was inversely related with cf-PWV/GLS and aa-PWV/GLS (all P < 0.01). Although cf-PWV/GLS and aa-PWV/GLS independently predicted peak VO2 in the overall population (adjusted R2 = 0.33 and R2= 0.36; all P < 0.0001), only aa-PWV/GLS was independently associated with flow reserve during exercise (R2 = 0.52; P < 0.0001).

Conclusions

Abnormal VAC is directly correlated with greater severity of HF and worse functional capacity. HFpEF shows a worse VAC than HFrEF when expressed by aa-PWV/GLS.

Key Words

heart failure
heart failure with preserved ejection fraction (HFpEF)
pulsed wave velocity
ventricular-arterial coupling (VAC)
exercise capacity

Abbreviations and Acronyms

aa-PWV
aortic arch pulsed wave velocity
AVO2diff
arterial-venous oxygen content difference
cf-PWV
carotid-femoral pulsed wave velocity
GLS
global longitudinal strain
HFpEF
heart failure with preserved ejection fraction
HFrEF
heart failure with reduced ejection fraction
SVR
systemic vascular resistance
TAC
total arterial compliance
VAC
ventricular-arterial coupling
VO2
oxygen consumption
Zc
aortic characteristic impedance

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