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Heart and Vessels

, Volume 33, Issue 8, pp 931–938 | Cite as

Wave intensity as a useful modality for assessing ventilation–perfusion imbalance in subclinical patients with hypertension

  • Yoshie Nogami
  • Yoshihiro Seo
  • Masayoshi Yamamoto
  • Tomoko Ishizu
  • Kazutaka Aonuma
Original Article
  • 46 Downloads

Abstract

Wave intensity (WI) is a novel noninvasive index of circulatory dynamics that reflects ventriculo-arterial coupling. It is calculated as the product of the first derivative of blood pressure and that of flow velocity measured by carotid echocardiography. This study aimed to clarify the clinical implications of WI and its relation with carbon dioxide production (VE/VCO2 slope). Twenty-one healthy volunteers (control group) and 21 patients with hypertension (HT group) underwent cardiopulmonary exercise testing (CPX) and exercise stress echocardiography. WI was assessed in the right carotid artery using an ultrasound system. The first peak of WI (W1) during the early ejection phase was measured at baseline and mitral annular velocity was assessed by tissue Doppler imaging. Ventilatory kinetics during exercise was assessed using the relation of minute ventilation to VE/VCO2 slope. VE/VCO2 slope, W1, and E/E′ were greater in the HT group than in the control group. PeakVO2 and VO2 at the anaerobic threshold were lower in the HT group than in the control group. VE/VCO2 slope was significantly correlated with W1 (r = 0.58, p < 0.01) and E/E′ (r = 0.44, p < 0.01). Stepwise multivariate analysis revealed that W1 was an independent determinant of VE/VCO2 slope (β = 0.43, p < 0.01). In conclusion, W1 might be able to predict the severity of heart failure without the need for CPX. Moreover, WI may be a useful modality in assessing heart failure pathophysiology based on ventriculo-arterial coupling.

Keywords

Wave intensity Carotid echocardiography Exercise capacity 

Notes

Acknowledgements

This study was supported by Professor Kiyomi Niki, Tokyo City University, and Motoaki Sugawara, Himeji Dokkyo University. The authors thank the technologists in the clinical laboratory at Tsukuba University Hospital for their help with the data collection.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest directly relevant to the content of this article.

References

  1. 1.
    Ohte N, Narita H, Sugawara M, Niki K, Okada T, Harada A, Hayano J, Kimura G (2003) Clinical usefulness of carotid arterial wave intensity in assessing left ventricular systolic and early diastolic performance. Heart Vessels 18:107–111CrossRefPubMedGoogle Scholar
  2. 2.
    Rakebrandt F, Palombo C, Swampillai J, Schön F, Donald A, Kozàkovà M, Kato K, Fraser AG (2009) Arterial wave intensity and ventricular-arterial coupling by vascular ultrasound: rationale and methods for the automated analysis of forwards and backwards running waves. Ultrasound Med Biol 35:266–277CrossRefPubMedGoogle Scholar
  3. 3.
    Cheng HM, Yu WC, Sung SH, Wang KL, Chuang SY, Chen CH (2008) Usefulness of systolic time intervals in the identification of abnormal ventriculo-arterial coupling in stable heart failure patients. Eur J Heart Fail 10:1192–1200CrossRefPubMedGoogle Scholar
  4. 4.
    Parker KH, Jones CJ (1990) Forward and backward running waves in the arteries: analysis using the method of characteristics. J Biomech Eng 112:322–326CrossRefPubMedGoogle Scholar
  5. 5.
    Davies JE, Whinnett ZI, Francis DP, Manisty CH, Aguado-Sierra J, Willson K, Foale RA, Malik IS, Hughes AD, Parker KH, Mayet J (2006) Evidence of a dominant backward-propagating “suction” wave responsible for diastolic coronary filling in humans, attenuated in left ventricular hypertrophy. Circulation 113:1768–1778CrossRefPubMedGoogle Scholar
  6. 6.
    Ha JW, Choi D, Park S, Choi EY, Shim CY, Kim JM, Ahn JA, Lee SW, Oh JK, Chung N (2009) Left ventricular diastolic functional reserve during exercise in patients with impaired myocardial relaxation at rest. Heart 95:399–404CrossRefPubMedGoogle Scholar
  7. 7.
    Balady GJ, Arena R, Sietsema K, Myers J, Coke L, Fletcher GF, Forman D, Franklin B, Guazzi M, Gulati M, Keteyian SJ, Lavie CJ, Macko R, Mancini D, Milani RV (2010) Interdisciplinary Council on Quality of Care and Outcomes Research. Clinician’s Guide to cardiopulmonary exercise testing in adults: a scientific statement from the American Heart Association. Circulation 122:191–225CrossRefPubMedGoogle Scholar
  8. 8.
    Kleber FX, Vietzke G, Wernecke KD, Bauer U, Opitz C, Wensel R, Sperfeld A, Gläser S (2000) Impairment of ventilatory efficiency in heart failure: prognostic impact. Circulation 101:2803–2809CrossRefPubMedGoogle Scholar
  9. 9.
    Banning AP, Lewis NP, Northridge DB, Elborn JS, Hendersen AH (1995) Perfusion/ventilation mismatch during exercise in chronic heart failure: an investigation of circulatory determinants. Br Heart J 74:27–33CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Reindl I, Wernecke KD, Opitz C, Wensel R, König D, Dengler T, Schimke I, Kleber FX (1998) Impaired ventilatory efficiency in chronic heart failure: possible role of pulmonary vasoconstriction. Am Heart J 136:778–785CrossRefPubMedGoogle Scholar
  11. 11.
    Francis DP, Shamim W, Davies LC, Piepoli MF, Ponikowski P, Anker SD, Coats AJ (2000) Cardiopulmonary exercise testing for prognosis in chronic heart failure: continuous and independent prognostic value from VE/VCO(2)slope and peak VO(2). Eur Heart J 21:154–161CrossRefPubMedGoogle Scholar
  12. 12.
    Arena R, Myers J, Aslam SS, Varughese EB, Peberdy MA (2004) Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison. Am Heart J 147:354–360CrossRefPubMedGoogle Scholar
  13. 13.
    Hoshimoto-Iwamoto M, Koike A, Nagayama O, Tajima A, Uejima T, Adachi H, Aizawa T, Wasserman K (2008) Determination of the VE/VCO2 slope from a constant work-rate exercise test in cardiac patients. J Physiol Sci 58:291–295CrossRefPubMedGoogle Scholar
  14. 14.
    Koike A, Wasserman K, McKenzie DK, Zanconato S, Weiler-Ravell D (1990) Evidence that diffusion limitation determines oxygen uptake kinetics during exercise in humans. J Clin Investig 86:1698–1706CrossRefPubMedGoogle Scholar
  15. 15.
    Koike A, Wasserman K, Taniguchi K, Hiroe M, Marumo F (1994) Critical capillary oxygen partial pressure and lactate threshold in patients with cardiovascular disease. J Am Coll Cardiol 23:1644–1650CrossRefPubMedGoogle Scholar
  16. 16.
    Devereux RB, Reichek N (1977) Echocardiographic determination of left ventricular mass in man. Anatomic validation of the method. Circulation 55:613–618CrossRefPubMedGoogle Scholar
  17. 17.
    Schiller NB, Shah PM, Crawford M, DeMaria A, Devereux R, Feigenbaum H, Gutgesell H, Reichek N, Sahn D, Schnittger I (1989) Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. American Society of Echocardiography Committee on Standards, Subcommittee on Quantitation of Two-Dimensional Echocardiograms. J Am Soc Echocardiogr 2:358–367CrossRefPubMedGoogle Scholar
  18. 18.
    Niki K, Sugawara M, Chang D, Harada A, Okada T, Sakai R, Uchida K, Tanaka R, Mumford CE (2002) A new noninvasive measurement system for wave intensity: evaluation of carotid arterial wave intensity and reproducibility. Heart Vessels 17:12–21CrossRefPubMedGoogle Scholar
  19. 19.
    Sugawara M, Niki K, Furuhata H, Ohnishi S, Suzuki S (2000) Relationship between the pressure and diameter of the carotid artery in humans. Heart Vessels 15:49–51CrossRefPubMedGoogle Scholar
  20. 20.
    Niki K, Sugawara M, Uchida K, Tanaka R, Tanimoto K, Imamura H, Sakomura Y, Ishizuka N, Koyanagi H, Kasanuki H (1999) A noninvasive method of measuring wave intensity, a new hemodynamic index: application to the carotid artery in patients with mitral regurgitation before and after surgery. Heart Vessels 14:263–271CrossRefPubMedGoogle Scholar
  21. 21.
    Sugawara M, Niki K, Ohte N, Okada T, Harada A (2009) Clinical usefulness of wave intensity analysis. Med Biol Eng Comput 47:197–206CrossRefPubMedGoogle Scholar
  22. 22.
    Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T (2013) Early predictors of alterations in left atrial structure and function related to left ventricular dysfunction in asymptomatic patients with hypertension. J Am Soc Hypertens 7:206–215CrossRefPubMedGoogle Scholar
  23. 23.
    Zile MR, Baicu CF, Gaasch WH (2004) Diastolic heart failure–abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med 350:1953–1959CrossRefPubMedGoogle Scholar
  24. 24.
    Vasan RS, Benjamin EJ, Levy D (1995) Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol 26:1565–1574CrossRefPubMedGoogle Scholar
  25. 25.
    Oe Y, Shimbo D, Ishikawa J, Okajima K, Hasegawa T, Diaz KM, Muntner P, Homma S, Schwartz JE (2013) Alterations in diastolic function in masked hypertension: findings from the masked hypertension study. Am J Hypertens 26:808–815CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Bassett DR Jr, Howley ET (2000) Limiting factors for maximum oxygen uptake and determinants of endurance performance. Med Sci Sports Exerc 32:70–84CrossRefPubMedGoogle Scholar
  27. 27.
    Näveri HK, Leinonen H, Kiilavuori K, Härkönen M (1997) Skeletal muscle lactate accumulation and creatine phosphate depletion during heavy exercise in congestive heart failure. Cause of limited exercise capacity? Eur Heart J 18:1937–1945CrossRefPubMedGoogle Scholar
  28. 28.
    Wilson JR, Martin JL, Ferraro N (1984) Impaired skeletal muscle nutritive flow during exercise in patients with congestive heart failure: role of cardiac pump dysfunction as determined by the effect of dobutamine. Am J Cardiol 53:1308–1315CrossRefPubMedGoogle Scholar
  29. 29.
    Davies SW, Fussell AL, Jordan SL, Poole-Wilson PA, Lipkin DP (1992) Abnormal diastolic filling patterns in chronic heart failure—relationship to exercise capacity. Eur Heart J 13:749–757CrossRefPubMedGoogle Scholar
  30. 30.
    Franciosa JA, Park M, Levine TB (1981) Lack of correlation between exercise capacity and indexes of resting left ventricular performance in heart failure. Am J Cardiol 47:33–39CrossRefPubMedGoogle Scholar
  31. 31.
    Lele SS, Macfarlane D, Morrison S, Thomson H, Khafagi F, Frenneaux M (1996) Determinants of exercise capacity in patients with coronary artery disease and mild to moderate systolic dysfunction. Role of heart rate and diastolic filling abnormalities. Eur Heart J 17:204–212CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan KK, part of Springer Nature 2018

Authors and Affiliations

  • Yoshie Nogami
    • 1
    • 2
  • Yoshihiro Seo
    • 2
  • Masayoshi Yamamoto
    • 2
  • Tomoko Ishizu
    • 2
  • Kazutaka Aonuma
    • 2
  1. 1.Faculty of Engineering, Department of Human Environmental SciencesShonan Institute of TechnologyFujisawaJapan
  2. 2.Department of Cardiology, Faculty of MedicineUniversity of TsukubaTsukubaJapan

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