European Journal of Echocardiography Advance Access originally published online on November 28, 2008
European Journal of Echocardiography 2009 10(3):425-432; doi:10.1093/ejechocard/jen304
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Proximal aortic stiffness is related to left ventricular function and exercise capacity in patients with dilated cardiomyopathy
Cardiology Department, Heraklion University Hospital, PO Box 1352 Stavrakia, Heraklion, Crete, Greece
Received 12 August 2008; accepted after revision 26 October 2008; online publish-ahead-of-print 28 November 2008.
* Corresponding author. Tel: +30 2810 392706; fax: +30 2810 542055. E-mail address: apatrianakos{at}yahoo.gr
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Abstract |
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Aims: Patients with heart failure (HF) show abnormal arterial stiffening.
Methods and results: We examined 60 patients (52.1 ± 12, 8 years) with non-ischaemic dilated cardiomyopathy (NIDC), New York Heart Association II–III, in sinus rhythm, left ventricular ejection fraction 30.1 ± 8.6%, and 44 normals. All subjects underwent an echocardiographic study and a cardiopulmonary exercise test. We evaluated the segmental proximal aorta (AO) pulse wave velocity (PWV) in the region of aortic arch with a new echo-method: from the suprasternal view, the distance between ascending and descending AO was measured with two-dimensional ultrasound, and the aortic flow wave transit time (TT) was measured with pulsed-wave Doppler. Pulse wave velocity was calculated as aortic distance/TT. Patients showed increased PWV (7.4 ± 2.9 vs. 4.8 ± 1.1 m/s, P < 0.001), compared with controls. Patients with advanced left ventricular (LV) (restrictive or pseudo-normal filling pattern) diastolic dysfunction showed increased PWV (8.6 ± 2.6 vs. 6.6 ± 2.9 m/s, P = 0.01) and reduced peak and predicted (for age, sex, and body mass) VO2 (both P < 0.001), compared with those with mild diastolic dysfunction (delayed relaxation filling pattern). Pulse wave velocity was significantly correlated with the LV mass (r = 0.32, P = 0.01), the peak spectral tissue Doppler imaging systolic wave (r = –0.34, P = 0.006), the LV diastolic filling pattern (r = 0.42, P = 0.001), and the peak (r = –0.47, P < 0.001) and predicted VO2 (r = –0.579, P < 0.001).
Conclusion: Patients with NIDC showed increased proximal aortic stiffness, which relates to LV systolic and diastolic function and exercise capacity. The echocardiographic assessment of the regional aorta PWV seems to be clinically important.
Keywords: Aorta; Heart failure; Echocardiography; Pulse wave velocity; Exercise test