Abstract
The objective is to investigate the relationship between arterial stiffness measured by arterial tonometry and echocardiographic indices of diastolic dysfunction—a basis for the diagnosis of heart failure with preserved ejection fraction (HFpEF). OvidSP Medline, Embase and PubMed were systematically searched. Eligible articles correlated arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV), carotid-femoral pulse wave velocity (cfPWV), augmentation index (AIx) or cardio-ankle vascular index (CAVI) with indices of diastolic dysfunction, E/A ratio, peak early mitral annular velocity (e′) and E/e′ ratio. Correlation coefficients were determined using a random-effects model. Twenty-seven studies with 6,626 patients were included. baPWV was significantly correlated with E/A ratio (r = −0.434, 95 % CI −0.387 to −0.479), e′ (r = −0.499, 95 % CI −0.448 to −0.548) and E/e′ ratio (r = 0.372, 95 % CI 0.251–0.481). cfPWV was significantly correlated with E/A ratio (r = −0.391, 95 % CI −0.304 to −0.470) and E/e′ ratio (r = 0.210, 95 % CI 0.300–0.116), but not e′. AIx was significantly correlated with E/A ratio (r = −0.356, 95 % CI −0.255 to −0.450), e′ (r = −0.313, 95 % CI −0.195 to −0.423) and E/e′ ratio (r = 0.321, 95 % CI 0.250–0.388). CAVI was significantly correlated with E/A ratio (r = −0.405, CI −0.324 to −0.481), e′ (r = −0.449, 95 % CI −0.340 to −0.630), but not E/e′. baPWV showed significantly greater correlation with diastolic dysfunction compared to most other tonometric techniques. Arterial stiffness measured by arterial tonometry is an indicator of diastolic dysfunction with baPWV demonstrated the most consistent and strongest association. These data suggest a refocusing on the impact of arterial stiffness on the left ventricle as a potential causative factor leading to HFpEF.
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References
Borlaug BA, Paulus WJ (2011) Heart failure with preserved ejection fraction: pathophysiology, diagnosis, and treatment. Eur Heart J 32:670–679
Butler J, Fonarow GC, Zile MR et al (2014) Developing therapies for heart failure with preserved ejection fractioncurrent state and future directions. JACC Heart Fail 2:97–112
Kane GC, Karon BL, Mahoney DW et al (2011) Progression of left ventricular diastolic dysfunction and risk of heart failure. JAMA 306:856–863. doi:10.1001/jama.2011.1201
Lam C, Lyass A, Kraigher-Krainer E et al (2011) Cardiac dysfunction and noncardiac dysfunction as precursors of heart failure with reduced and preserved ejection fraction in the community. Circulation 124:24–30. doi:10.1161/CIRCULATIONAHA.110.979203
Tschope C, Paulus WJ (2009) Is echocardiographic evaluation of diastolic function useful in determining clinical care? Doppler echocardiography yields dubious estimates of left ventricular diastolic pressures. Circulation 120:810–820
Nagueh SF, Appleton CP, Gillebert TC et al (2009) Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr 22:107–133
Little WC, Oh JK (2009) Echocardiographic evaluation of diastolic function can be used to guide clinical care. Circulation 120:802–809
Ogunyankin KO (2011) Assessment of left ventricular diastolic function: the power, possibilities, and pitfalls of echocardiographic imaging techniques. Can J Cardiol 27:311–318
Garcia MJ, Thomas JD, Klein AL (1998) New Doppler echocardiographic applications for the study of diastolic function. J Am Coll Cardiol 32:865–875
Nishimura RA, Tajik AJ (1997) Evaluation of diastolic filling of left ventricle in health and disease: Doppler echocardiography is the clinician’s Rosetta Stone. J Am Coll Cardiol 30:8–18
Farias CA, Rodriguez L, Garcia MJ et al (1999) Assessment of diastolic function by tissue doppler echocardiography: comparison with standard transmitral and pulmonary venous flow. J Am Soc Echocardiogr 12:609–617. doi:10.1053/je.1999.v12.a99249
Wang M, Yip GWK, Wang AYM et al (2003) Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value. J Am Coll Cardiol 41:820–826
Ommen SR, Nishimura RA, Appleton CP et al (2000) Clinical utility of Doppler echocardiography and tissue doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 102:1788–1794. doi:10.1161/01.CIR.102.15.1788
Sohn D-W, Chai I-H, Lee D-J et al (1997) Assessment of mitral annulus velocity by Doppler tissue imaging in the evaluation of left ventricular diastolic function. J Am Coll Cardiol 30:474–480
Kasner M, Westermann D, Steendijk P et al (2007) Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation 116:637–647. doi:10.1161/CIRCULATIONAHA.106.661983
Chung C-MM, Chu C-MM, Chang S-TT et al (2010) Quantification of aortic stiffness to predict the degree of left ventricular diastolic function. Am J Med Sci 340:468–473
Desai AS, Mitchell GF, Fang JC et al (2009) Central aortic stiffness is increased in patients with heart failure and preserved ejection fraction. J Card Fail 15:658–664
Chow B, Rabkin SW (2013) Brachial-ankle pulse wave velocity is the only index of arterial stiffness that correlates with a mitral valve indices of diastolic dysfunction, but no index correlates with left atrial size. Cardiol Res Pract 2013:986847
Groenink M, de Roos A, Mulder BJM et al (1998) Changes in aortic distensibility and pulse wave velocity assessed with magnetic resonance imaging following beta-blocker therapy in the marfan syndrome. Am J Cardiol 82:203–208. doi:10.1016/S0002-9149(98)00315-4
Mackenzie IS, Wilkinson IB, Cockcroft JR (2002) Assessment of arterial stiffness in clinical practice. QJM 95:67–74. doi:10.1093/qjmed/95.2.67
DeLoach SS, Townsend RR (2008) Vascular stiffness: its measurement and significance for epidemiologic and outcome studies. Clin J Am Soc Nephrol 3:184–192. doi:10.2215/CJN.03340807
Nakae I, Matsuo S, Matsumoto T et al (2008) Augmentation index and pulse wave velocity as indicators of cardiovascular stiffness. Angiology 59:421–426
Asmar R, Topouchian J, Pannier B et al (2001) Pulse wave velocity as endpoint in large-scale intervention trial. The Complior(R) study. J Hypertens 19:813–818
Takaki A, Ogawa H, Wakeyama T et al (2008) Cardio-ankle vascular index is superior to brachial-ankle pulse wave velocity as an index of arterial stiffness. Hypertens Res–Clin Exp 31:1347–1355
Munakata M, Nunokawa T, Yoshinaga K, Toyota T (2005) The brachial-ankle pulse wave velocity is a better predictor for pulse pressure than augmentation index in older hypertensives. Jpn Med Assoc J 48:224–233
Weber T, Ammer M, Rammer M et al (2009) Noninvasive determination of carotid-femoral pulse wave velocity depends critically on assessment of travel distance: a comparison with invasive measurement. J Hypertens 27:1624–1630
Nürnberger J, Keflioglu-Scheiber A, Opazo Saez AM et al (2002) Augmentation index is associated with cardiovascular risk. J Hypertens 20:2407–2414. doi:10.1097/01.hjh.0000045501.82010.fa
Sakane K, Miyoshi T, Doi M et al (2008) Association of new arterial stiffness parameter, the cardio-ankle vascular index, with left ventricular diastolic function. J Atheroscler Thromb 15:261–268
Wang CP, Hung WC, Yu TH et al (2009) Brachial-ankle pulse wave velocity as an early indicator of left ventricular diastolic function among hypertensive subjects. Clin Exp Hypertens (New York) 31:31–43
Hsu P-CC, Lin T-HH, Lee C-SS et al (2010) Mismatch between arterial stiffness increase and left ventricular diastolic dysfunction. Heart Vessel 25:485–492
Hsu P-C, Lin T-H, Lee C-S et al (2011) Impact of a systolic parameter, defined as the ratio of right brachial pre-ejection period to ejection time, on the relationship between brachial-ankle pulse wave velocity and left ventricular diastolic function. Hypertens Res 34:462–467
Hsu P-C, Tsai W-C, Lin T-H et al (2012) Association of arterial stiffness and electrocardiography-determined left ventricular hypertrophy with left ventricular diastolic dysfunction. PLoS One 7:e49100
Masugata H, Senda S, Goda F et al (2009) Tissue Doppler echocardiography for predicting arterial stiffness assessed by cardio-ankle vascular index. Tohoku J Exp Med 217:139–146
Masugata H, Senda S, Okuyama H et al (2010) Aortic annular velocity assessed by tissue Doppler echocardiography as a potential parameter of arterial stiffness. Tohoku J Exp Med 221:169–174
Field AP (2001) Meta-analysis of correlation coefficients: a Monte Carlo comparison of fixed- and random-effects methods. Psychol Methods 6:161–180
Moher D, Liberati A, Tetzlaff J et al (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. J Clin Epidemiol 62:1006–1012
Yambe M, Tomiyama H, Hirayama Y et al (2001) Arterial stiffening as a possible risk factor for both atherosclerosis and diastolic heart failure. Hypertens Res 27:625–631
Masugata H, Senda S, Yoshikawa K et al (2005) Relationships between echocardiographic findings, pulse wave velocity, and carotid atherosclerosis in type 2 diabetic patients. Hypertens Res–Clin Exp 28:965–971
Tsioufis C, Chatzis D, Dimitriadis K et al (2005) Left ventricular diastolic dysfunction is accompanied by increased aortic stiffness in the early stages of essential hypertension: a TDI approach. J Hypertens 23:1745–1750
Mizuguchi Y, Oishi Y, Tanaka H et al (2007) Arterial stiffness is associated with left ventricular diastolic function in patients with cardiovascular risk factors: early detection with the use of cardio-ankle vascular index and ultrasonic strain imaging. J Card Fail 13:744–751
Ikonomidis I, Tzortzis S, Papaioannou T et al (2008) Incremental value of arterial wave reflections in the determination of left ventricular diastolic dysfunction in untreated patients with essential hypertension. J Hum Hypertens 22:687–698
Kaji Y, Miyoshi T, Doi M et al (2009) Augmentation index is associated with B-type natriuretic peptide in patients with paroxysmal atrial fibrillation. Hypertens Res 32:611–616
Libhaber CD, Norton GR, Majane OH et al (2009) Contribution of central and general adiposity to abnormal left ventricular diastolic function in a community sample with a high prevalence of obesity. Am J Cardiol 104:1527–1533
Fukuta H, Ohte N, Wakami K et al (2010) Impact of arterial load on left ventricular diastolic function in patients undergoing cardiac catheterization for coronary artery disease. Circ J 74:1900–1905
Kang S, Fan H-M, Li J et al (2010) Relationship of arterial stiffness and early mild diastolic heart failure in general middle and aged population. Eur Heart J 31:2799–2807
Triantafyllidi H, Tzortzis S, Lekakis J et al (2010) Association of target organ damage with three arterial stiffness indexes according to blood pressure dipping status in untreated hypertensive patients. Am J Hypertens 23:1265–1272
Noguchi S, Masugata H, Senda S et al (2011) Correlation of arterial stiffness to left ventricular function in patients with reduced ejection fraction. Tohoku J Exp Med 225:145–151
Shim CY, Park S, Choi D et al (2011) Sex differences in central hemodynamics and their relationship to left ventricular diastolic function. J Am Coll Cardiol 57:1226–1233
Soldatos G, Jandeleit-Dahm K, Thomson H et al (2011) Large artery biomechanics and diastolic dysfunction in patients with Type 2 diabetes. Diabet Med 28:54–60
Usui Y, Takata Y, Inoue Y et al (2011) Severe obstructive sleep apnea impairs left ventricular diastolic function in non-obese men. Sleep Med 4:4
Han J-Y, Choi D-H, Choi S-W et al (2012) Predictive value of brachial-ankle pulse wave velocity for cardiovascular events. Am J Med Sci 346:92–97
Roos CJ, Auger D, Djaberi R et al (2013) Relationship between left ventricular diastolic function and arterial stiffness in asymptomatic patients with diabetes mellitus. Int J Cardiovasc Imaging 29:609–616
Takami T, Saito Y (2013) Azelnidipine plus olmesartan versus amlodipine plus olmesartan on arterial stiffness and cardiac function in hypertensive patients: a randomized trial. Drug Des Dev Ther 7:175–183
Canepa M, Alghatrif M, Strait JB et al (2014) Early contribution of arterial wave reflection to left ventricular relaxation abnormalities in a community-dwelling population of normotensive and untreated hypertensive men and women. J Hum Hypertens 28:85–91
Matsui Y, Kario K, Ishikawa J et al (2005) Smoking and antihypertensive medication: interaction between blood pressure reduction and arterial stiffness. Hypertens Res 28:631–638
Kelly RP, Millasseau SC, Ritter JM, Chowienczyk PJ (2001) Vasoactive drugs influence aortic augmentation index independently of pulse-wave velocity in healthy men. Hypertension 37:1429–1433. doi:10.1161/01.HYP.37.6.1429
Yasmin Brown MJ (1999) Similarities and differences between augmentation index and pulse wave velocity in the assessment of arterial stiffness. QJM 92:595–600. doi:10.1093/qjmed/92.10.595
Tanaka H, Munakata M, Kawano Y et al (2009) Comparison between carotid-femoral and brachial-ankle pulse wave velocity as measures of arterial stiffness. J Hypertens 27:2022–2027
Yu WC, Chuang SY, Lin YP, Chen CH (2008) Brachial-ankle vs carotid-femoral pulse wave velocity as a determinant of cardiovascular structure and function. J Hum Hypertens 22:24–31
Tsai WC, Lee KT, Kuo HF et al (2013) Association of increased arterial stiffness and p wave dispersion with left ventricular diastolic dysfunction. Int J Med Sci 10:1437–1444
Chuang S-Y, Chen C-H, Cheng C-M, Chou P (2005) Combined use of brachial-ankle pulse wave velocity and ankle-brachial index for fast assessment of arteriosclerosis and atherosclerosis in a community. Int J Cardiol 98:99–105. doi:10.1016/j.ijcard.2004.01.019
Shirai K, Utino J, Otsuka K, Takata M (2006) A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb 13:101–107
Kubozono T, Miyata M, Ueyama K et al (2007) Clinical significance and reproducibility of new arterial distensibility index. Circ J 71:89–94
Zile MR, Brutsaert DL (2002) New concepts in diastolic dysfunction and diastolic heart failure: part II: causal mechanisms and treatment. Circulation 105:1503–1508
Laurent S, Cockcroft J, Van Bortel L et al (2006) Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J 27:2588–2605
Vlachopoulos C, Aznaouridis K, Stefanadis C (2010) Prediction of cardiovascular events and all-cause mortality with arterial stiffness: a systematic review and meta-analysis. J Am Coll Cardiol 55:1318–1327
Vlachopoulos C (2012) Progress towards identifying biomarkers of vascular aging for total cardiovascular risk prediction. J Hypertens 30:S19–S26
Safar ME, Levy BI, Struijker-Boudier H (2003) Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation 107:2864–2869
O’Rourke MF (2001) Diastolic heart failure, diastolic left ventricular dysfunction and exercise intolerance. J Am Coll Cardiol 38:803–805
Rabkin SW, Chan SH (2012) Correlation of pulse wave velocity with left ventricular mass in patients with hypertension once blood pressure has been normalized. Heart Int 7:27–31
Lyman GH, Kuderer NM (2005) The strengths and limitations of meta-analyses based on aggregate data. BMC Med Res Methodol 5:14
Coutinho T, Borlaug BA, Pellikka PA et al (2013) Sex differences in arterial stiffness and ventricular–arterial interactions. J Am Coll Cardiol 61:96–103
Jüni P, Holenstein F, Sterne J et al (2002) Direction and impact of language bias in meta-analyses of controlled trials: empirical study. Int J Epidemiol 31:115–123
Egger M, Zellweger-Zähner T, Schneider M et al (1997) Language bias in randomised controlled trials published in English and German. Lancet 350:326–329. doi:10.1016/S0140-6736(97)02419-7
Grégoire G, Derderian F, Le Lorier J (1995) Selecting the language of the publications included in a meta-analysis: is there a tower of babel bias? J Clin Epidemiol 48:159–163. doi:10.1016/0895-4356(94)00098-B
Moher D, Pham Klassen TP et al (2000) What contributions do languages other than English make on the results of meta-analyses? J Clin Epidemiol 53:964–972. doi:10.1016/S0895-4356(00)00188-8
Ehler D, Carney DK, Dempsey AL et al (2001) Guidelines for cardiac sonographer education: recommendations of the american society of echocardiography sonographer training and education committee. J Am Soc Echocardiogr 14:77–84. doi:10.1067/mje.2001.109922
Deeks JJ, Higgins JPT, Altman DG (2011) Analysing data and undertaking meta-analyses. Cochrane Handb. Syst. Rev. Interv. Version 5.1.0
Chung CS, Strunc A, Oliver R, Kovacs SJ (2006) Diastolic ventricular-vascular stiffness and relaxation relation: elucidation of coupling via pressure phase plane-derived indexes. Am J Physiol–Heart Circ Physiol 291:H2415–H2423
Haluska BA, Jeffriess L, Brown J et al (2010) A comparison of methods for assessing total arterial compliance. J Hum Hypertens 24:254–262
Cohn JN, Finkelstein S, McVeigh G et al (1995) Noninvasive pulse wave analysis for the early detection of vascular disease. Hypertension 26:503–508
Mitchell GF, Lacourciere Y, Arnold JM et al (2005) Changes in aortic stiffness and augmentation index after acute converting enzyme or vasopeptidase inhibition. Hypertension 46:1111–1117
Sun CK (2013) Cardio-ankle vascular index (CAVI) as an indicator of arterial stiffness. Integr Blood Press Control 6:27–38
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Chow, B., Rabkin, S.W. The relationship between arterial stiffness and heart failure with preserved ejection fraction: a systemic meta-analysis. Heart Fail Rev 20, 291–303 (2015). https://doi.org/10.1007/s10741-015-9471-1
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DOI: https://doi.org/10.1007/s10741-015-9471-1