P1.17 Arterial Stiffness is Related to Left Ventricular Diastolic Dysfunction in Dilated Cardiomyopathy

Abstract

Aim

To evaluate the relationship between left ventricular (LV) diastolic and systolic function, arterial stiffness and endothelial function in patients with dilated cardiomyopathy (DCM)

Methods

In 54 patients with DCM (age 63±13 years, 10 females) and LV ejection fraction (EF)<45%, applanation tonometry (Sphygmocor®) was evaluated for determining augmentation index (AIx) and pulse pressure (PP) amplification (brachial PP / central PP%) by pulse wave analysis and carotid to femoral pulse wave velocity (PWV). Endothelium-dependent (flow-mediated dilation, FMD, after 5-minute of forearm ischemia) and independent (sublingual glycerol trinitrate, GTN, 25 µg) vasodilation were assessed by ultrasounds and computerized analysis of brachial artery diameter changes. A Doppler and echocardiographic study was also performed, for measurements of E/A ratio and E wave deceleration time (ETD).

Results

Mean LV EF was 32±10%. AIx was related to E/A ratio (r = −0.51; p<0.01) and EDT (r = 0.36; p<0.05). PP amplification correlated with E/A ratio (r = 0.61; p<0.0001) and EDT (r = −0.36; p<0.05). PWV was associated with EDT (r = 0.36; p<0.05). A significant correlation was found between PP amplification and LV EF (r = −0.33; p<0.05). No significant correlations were apparent between FMD, response to GTN and FMD/GTN ratio with respect to indexes of LV systolic and diastolic function.

Conclusions

In DCM patients, arterial stiffness is related to LV diastolic dysfunction, indicating that increased arterial stiffness is associated with either restrictive or pseudo-normal LV filling. Pulse wave amplification is directly related to diastolic parameters and inversely to systolic function, suggesting lesser central pressure augmentation rather than increased peripheral amplification.