Highlights
- •Reflection magnitude and the magnitude of the reflected wave are associated with increased HF risk in a large population of healthy community-dwelling individuals, after comprehensive adjustment for risk factors known to be associated with HF risk and the presence of subclinical atherosclerosis.
- •Systemic vascular resistance and effective arterial elastance are not independently associated with HF. This indicates that resistive arterial load is not related to HF risk, whereas effective arterial elastance, a commonly used parameter of arterial load, fails to capture important prognostic information in pulsatile load patterns.
- •Our findings emphasize the importance of the loading sequence and of assessing pulsatile load with the use of time-resolved arterial waveforms.
Abstract
Background
Left ventricular (LV) afterload is composed of systemic vascular resistance (SVR)
and components of pulsatile load, including total arterial compliance (TAC), and reflection
magnitude (RM). RM, which affects the LV systolic loading sequence, has been shown
to strongly predict HF. Effective arterial elastance (Ea) is a commonly used parameter initially proposed to be a lumped index of resistive
and pulsatile afterload. We sought to assess how various LV afterload parameters predict
heart failure (HF) risk and whether RM predicts HF independently from subclinical
atherosclerosis.
Methods
We studied 4345 MESA participants who underwent radial arterial tonometry and cardiac
output (CO) measurements with the use of cardiac MRI. RM was computed as the ratio
of the backward (Pb) to forward (Pf) waves. TAC was approximated as the ratio of stroke volume (SV) to central pulse
pressure. SVR was computed as mean pressure/CO. Ea was computed as central end-systolic pressure/SV.
Results
During 10.3 years of follow-up, 91 definite HF events occurred. SVR (P = .74), TAC (P = .81), and Ea (P = .81) were not predictive of HF risk. RM was associated with increased HF risk,
even after adjustment for other parameters of arterial load, various confounders,
and markers of subclinical atherosclerosis (standardized hazard ratio [HR] 1.49, 95%
confidence interval [CI] 1.18–1.88; P = .001). Pb was also associated with an increased risk of HF after adjustment for Pf (standardized HR 1.43, 95% CI 1.17–1.75; P = .001).
Conclusions
RM is an important independent predictor of HF risk, whereas TAC, SVR, and Ea are not. Our findings support the importance of the systolic LV loading sequence
on HF risk, independently from subclinical atherosclerosis.
Key Words
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Article info
Publication history
Published online: April 19, 2016
Accepted:
April 18,
2016
Received in revised form:
April 5,
2016
Received:
October 7,
2015
Footnotes
Funding: This research was supported by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-HC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, a, and N01-HC-95169 from the National Heart, Lung, and Blood Institute (NHLBI) and grants UL1-TR-000040 and UL1-TR-001079 from the National Center for Research Resources. Dr Zamani was supported by the Institute for Translational Medicine and Therapeutics of the University of Pennsylvania (grant no. 5UL1TR000003-09 from the National Center for Research Resources) and by grant 5-T32-HL007843-17 from the NHLBI. Dr Chirinos was funded by grants 5R21AG043802-02 (National Institute of Aging), 1R56HL124073-01A1 (NHLBI), and 1 R01 HL121510-01A1 (NHLBI).
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© 2016 Elsevier Inc. All rights reserved.
