Arterial Stiffness Is Associated With Left Ventricular Diastolic Function in Patients With Cardiovascular Risk Factors: Early Detection With the Use of Cardio-Ankle Vascular Index and Ultrasonic Strain Imaging

Abstract 

Background

It is well known that left ventricular (LV) diastolic function declines in the elderly, especially in patients with cardiovascular risk factors. However, few data are available on the early detection of relationship between arterial stiffness and LV diastolic dysfunction.

Methods and Results

The common carotid artery intima-media thickness (IMT) and cardio-ankle vascular index (CAVI) were measured to determine the presence of subclinical atherosclerosis in 30 patients (13 men and 17 women; mean age 59 ± 5.7 years) with 1 or more cardiovascular risk factors. LV systolic and diastolic function also were determined by measuring transmitral flow velocity, mitral annular motion velocity, and myocardial strain and strain rate profiles using pulsed Doppler, tissue velocity, and ultrasonic strain imaging. The CAVI correlated with the peak early diastolic velocity of transmitral flow velocity (r = −0.50, P < .01), the ratio of peak early to late diastolic transmitral flow velocity (r = −0.37, P < .05), the deceleration time from peak to baseline of the early diastolic transmitral flow velocity (r = 0.57, P < .01), the peak early diastolic mitral annular motion velocity (r = −0.41, P < .05), and the peak early diastolic strain rates at the endocardial sites of the LV posterior and inferior walls (r = 0.61, P < .001; r = 0.56, P < .001, respectively). There were no relationships between CAVI and LV ejection fraction, peak systolic mitral annular motion velocity, or peak systolic strain rates of the LV walls. Multiple regression analysis revealed that the early diastolic strain rates at the endocardial sites of the LV walls are strongly correlated with CAVI. There were no relationships between the IMT and the LV systolic and diastolic parameters.

Conclusion

These results suggest that cardiovascular risk factors interact to affect arterial stiffness and LV relaxation, and therefore support the importance of screening using CAVI and ultrasonic strain imaging and early intervention in this patient population.

Key Words: Strain rate, arterial stiffness, left ventricular diastolic function, cardio-ankle vascular index