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The importance of calibration method in determining the association between central blood pressure with left ventricular and left atrial strain

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Afterload is an important determinant of left ventricular (LV) and atrial (LA) function, including myocardial strain. Central blood pressure (CBP) is the major component of cardiac afterload and independently associated with cardiovascular risk. However, the optimal means of calibrating CBP is unclear—standard CBP assessment uses systolic (SBP) and diastolic blood pressure (DBP) from brachial waveforms, but calibration with mean pressure (MAP) and DBP purports to be more accurate. Therefore, we sought to determine which CBP is best associated with LA and LV strain. CBP was measured using both standard and MAP based calibration methods in 546 participants (age 70.7 ± 4.7 years, 45% male) with risk factors for heart failure. Echocardiography was performed in all patients and strain analysis conducted to assess LA/LV function. The associations of CBP with LA and LV strain were assessed using linear regression. MAP-derived CSBP (150 ± 20 mmHg) was higher than standard CSBP (128 ± 15 mmHg) and brachial SBP (140 ± 17 mmHg, p < 0.001), whereas DBPs were similar (84 ± 10, 83 ± 10, and 82 ± 10 mmHg). MAP-derived CSBP was not independently associated with LV strain (p > 0.05), however was independently associated with LA reservoir strain (p < 0.05). Brachial and central DBP were more strongly associated with LA reservoir/conduit and LV strain than brachial and central SBP. LA pump strain was not independently associated with any SBP or DBP parameter (p > 0.05). MAP-derived CBP was more accurate in identifying patients with abnormal LA and LV strain than brachial SBP and standard CBP calibration. In conclusion, CBP calibrated using MAP and DBP may be more accurate in identifying patients with abnormal LA and LV function than standard brachial calibration methods.

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Angiotensin converting enzyme inhibitors


Atrial fibrillation


Body Mass Index


Blood pressure


Central blood pressure


Diastolic blood pressure




Global longitudinal strain


Heart failure


Left atrium


Left ventricle


Left ventricular ejection fraction


Left ventricular hypertrophy


Left ventricular mass


Mean arterial pressure


Systolic blood pressure


Type II diabetes mellitus


Tasmanian AF screening cohort


Transthoracic echocardiography


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S.R is supported by a research scholarship by the National Heart Foundation of Australia. This study was partially supported by Diabetes Australia, the Tasmanian Community Fund and Siemens Healthcare Australia. ECG equipment and software support were provided by Semacare Inc, a manufacturer of handheld ECG devices. The sponsors had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript.

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Correspondence to Satish Ramkumar.

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Ramkumar, S., Yang, H., Nolan, M. et al. The importance of calibration method in determining the association between central blood pressure with left ventricular and left atrial strain. Int J Cardiovasc Imaging 38, 589–600 (2022).

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