P.058 Left Ventricular Function in Relation to Arterial Stiffness in Hypertension. The Prognostic Importance of Pulse Pressure in LV Remodelling — Preliminary Report

Abstract

Background

Increased arterial stiffness has been reported to affect LV diastolic function in hypertension. Pulse pressure (PP) is independently related to cardiovascular and all-cause mortality. Strain and strain rate deformation parameters can detect subtle changes of the left ventricular (LV) function.

Aim

To investigate the role of arterial stiffness in Systolic LV function and the effect of Pulse pressure in hypertension.

Methods

We studied 55 consecutive hypertensive patients and 25 controls, matched for age (49.7±5.7 vs. 45.5±4.1 yrs), with normal EF (66±2.5 vs. 64±3.3%, NS). All subjects had 2D and colour doppler myocardial imaging of basal and mid LV segments (12) in the longitudinal axis. Mean longitudinal strain (S) and strain rate (SR) were averaged from each of the 12 segments assessed. Pulse wave velocity (PWV) carotid-femoral was used for estimation of arterial compliance in 20 of the hypertensive patients.

Results

The hypertensive group had higher pulse pressure (59.5±16.6 vs. 41.4±7.2 mmHg, P <0.001), and lower mean longitudinal S and SR (S: 18.1±2.2 vs. 20.5±2.0% P < 0.05 and SR: 1.34±0.16 vs. 1.54±0.13/s P < 0.05) compared to control. The patients with hypertrophy or diastolic dysfunction (DD) had higher PP than those without hypertrophy (65±15 vs. 46±11 mmHg, P <0.001) or DD (63±16 vs. 44±12 mmHg, P <0.001). Pulse pressure was correlated with LVMI (r = 0.51, P < 0.001), WT (r = 0.61, P < 0.001), RWT (r = 0.52, P < 0.001), mean SR (f = –0.58, P < 0.001), mean S (f = –0.51, P < 0.001), DT(r = 0.36, P < 0.05), A (r = 0.45, P < 0.05) and E/A (f = –0.54, P < 0.01). PWV was correlated with mean S and SR (f = –0.58, P < 0.05 and f = –0.49, P < 0.05) and PP (r = 0.47, P < 0.05).

Conclusion

Pulse pressure is related with functional (S, SR) and structural (WT, LVMI, RWT) components of the left ventricle and with the arterial stiffness. Arterial stiffness seems to affect not only the diastolic, but also the longitudinal systolic function of the left ventricle.