Change in arterial stiffness predicts left ventricular remodeling in women
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Key takeaways:
- An increase in cardio-ankle vascular index was independently associated with worsening global longitudinal strain.
- The association was only observed among women.
Among women without CVD, an increase in arterial stiffness is independently linked to worsening left ventricular global longitudinal strain, showing the role of vascular-ventricular coupling in the progression of LV remodeling, data show.
“Previous cross-sectional studies demonstrated that arterial stiffening is associated with increased LV afterload, and LV morphological and functional abnormalities suggesting an important role of vascular-ventricular coupling in the pathophysiology of HF,” Koki Nakanishi, MD, of the department of cardiovascular medicine at the University of Tokyo Graduate School of Medicine, and colleagues wrote in the study background. “However, the contribution of increased arterial stiffness to incident HF is not fully established and the studies on the topic have provided conflicting results.”
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In a retrospective study, Nakanishi and colleagues analyzed data from 317 adults without CVD at baseline who underwent repeated CV exams including transthoracic echocardiography and assessment of cardio-ankle vascular index as a measure of arterial stiffness. The median age of participants was 63 years and 58% were men. Participants with an ankle-brachial index of less than 0.9 or at least 1.4 were excluded from the study.
The findings were published in JACC: Advances.
During a median follow-up of 26.8 months, researchers observed an increase in cardio-ankle vascular index (P < .001). Generalized estimating equation analyses showed that a longitudinal increase in cardio-ankle vascular index was associated with impaired LV global longitudinal strain (estimate, 0.46; 95% CI, 0.11-0.82; P = .01) after adjustment for demographics and baseline CV factors, but not with changes of LV mass index and e’ velocity.
When controlling for longitudinal change of covariates, researchers found that cardio-ankle vascular index progression remained associated with change in LV global longitudinal strain (estimate, 0.5; 95% CI, 0.16-0.85; P = .004).
In sex-stratified analysis, progression of cardio-ankle vascular index was associated with LV global longitudinal strain deterioration in women but not men (estimate, 0.92; 95% CI, 0.27-1.58; P = .006).
“The greater progression in arterial stiffness was significantly associated with adverse LV remodeling even at an early, subclinical stage before LVEF decreases,” the researchers wrote. “In addition, sex-specific differences existed in the relationship.”
The researchers noted that research is needed to investigate whether early therapeutic intervention for CV risk factors may reverse decreased LV global longitudinal strain and possibly prevent HF by improving vascular function.
“Furthermore, the pathophysiological mechanisms behind the observed sex differences in vascular-ventricular uncoupling should be addressed,” they wrote.
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