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Impact of aortic root size on left ventricular afterload and stroke volume

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Abstract

Purpose

The left ventricle (LV) ejects blood into the proximal aorta. Age and hypertension are associated with stiffening and dilation of the aortic root, typically viewed as indicative of adverse remodeling. Based on analytical considerations, we hypothesized that a larger aortic root should be associated with lower global afterload (effective arterial elastance, EA) and larger stroke volume (SV). Moreover, as antihypertensive drugs differ in their effect on central blood pressure, we examined the role of antihypertensive drugs for the relation between aortic root size and afterload.

Methods

We studied a large group of patients (n = 1250; 61 ± 12 years; 78 % males; 64 % hypertensives) from a single-center registry with known or suspected coronary artery disease. Aortic root size was measured by echocardiography as the diameter of the tubular portion of the ascending aorta. LV outflow tract Doppler was used to record SV.

Results

In the population as a whole, after adjusting for key covariates in separate regression models, aortic root size was an independent determinant of both SV and EA. This association was found to be heterogeneous and stronger in patients taking a calcium channel blocker (CCB; 10.6 % of entire population; aortic root size accounted for 8 % of the explained variance of EA).

Conclusion

Larger aortic root size is an independent determinant of EA and SV. This association was heterogeneous and stronger in patients on CCB therapy.

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Abbreviations

ACE:

Angiotensin-converting enzyme

AR:

Aortic regurgitation

BSA:

Body surface area

CA :

Arterial compliance

CAFÉ:

Conduit artery functional evaluation

CCB:

Calcium channel blocker

EA :

Arterial elastance

ELV :

End-systolic LV elastance

LIFE:

Losartan for endpoint reduction trial

LV:

Left ventricle

LVEDV:

Left ventricular end-diastolic volume

LVEF:

Left ventricular ejection fraction

LVESP:

Left ventricular end-systolic pressure

LVESV:

Left ventricular end-systolic volume

MAP:

Mean arterial pressure

SD:

Standard deviation

SMC:

Smooth muscle cell

SV:

Stroke volume

SVR:

Systemic vascular resistance

ZC :

Characteristic impedance

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Authors and Affiliations

  1. National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore

    Anders Sahlén, Nadira Hamid, Mohammed Rizwan Amanullah, Jiang Ming Fam, Khung Keong Yeo, Yee How Lau, Carolyn S. P. Lam & Zee Pin Ding

  2. Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, 141 86, Stockholm, Sweden

    Anders Sahlén

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  1. Anders Sahlén
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  2. Nadira Hamid
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  3. Mohammed Rizwan Amanullah
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  4. Jiang Ming Fam
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Correspondence to Anders Sahlén.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Communicated by Keith Phillip George.

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Sahlén, A., Hamid, N., Amanullah, M.R. et al. Impact of aortic root size on left ventricular afterload and stroke volume. Eur J Appl Physiol 116, 1355–1365 (2016). https://doi.org/10.1007/s00421-016-3392-0

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  • DOI: https://doi.org/10.1007/s00421-016-3392-0

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