DOI: https://doi.org/10.30841/2307-5112.5.2018.166802

Arterial Stiffness and Ventricular Arterial Coupling and Pulsatative Load on the Left Ventricle in Patients with Hypertension with Initial and Fulminant Heart Failure and Preserved Ejection Fraction According to E/e’ Estimates

К. М. Амосова, О. В. Василенко, Ю. В. Руденко, А. Б. Безродний, Г. В. Мостбауер, К. І. Черняєва, І. В. Прудкий, Н. В. Шишкіна, Ю. О. Сиченко, А. В. Саблін, Д. М. Сербін, Б. В. Гуськов, Н. В. Мельніченко

Abstract


The objective: was to evaluate the cardiac structure and the contribution of arterial and ventricular stiffness to the mechanism of impaired cardiac hemodynamics and the development of clinical symptoms of HFpEF.

Materials and methods. We attracted to the study prospectively 103 haemodynamically stable patients 43 to 85 years (mean age 65,4±10,8 years) with clinical signs and symptoms of HF with NYHA II–III with hypertension 1 degree that treated with antihypertensive therapy and EF LV ≥50%, signs of DD according to Doppler echoCG. Patients were tested for the levels of the NTproBNP, in addition to standard laboratory parameters. The pulse wave velocity (carotid-femoral) and hemodynamic indices were determined using aplanation tonometry. Echocardiography was determined standard values and diastolic stress test was obtained. HFpEF was diagnosis according to the recommendations of ESC2016. In case of presence or absence of elevation of E/E’ at rest >13 in addition to the structural criteria, patients were divided into three groups. Group 1 consisted of patients with levels of NTproBNP <125 pg/ml and having the structural criteria and group 2 allocated to the patient’s in the presence of structural criteria level NTproBNP > 125 pg/ml, patients that with levels of NTproBNP >125 mg including elevated levels of E/E’ > 13 made group 3.

Results. The groups 1 (without HF) consisted of 11 (10.6%) group 2 – 28 (27,18%), the groups have 3 – 64 (62,1%) patients. Signs of NYHA II were present in all patients of the 1st group and in 78,5% – 2 groups (p>0,05), whereas in group 3 NYHA ІІІ (64,0%) prevailed (p<0,01). The NTproBNP level progressively increased from 1 to 3 groups (all p<0,01). According to EchoCG, there was an increase in end diastolic index and end systolic index in patients of group 3, compared with those in group 1, was accompanied to decrease in LV EF (by 11,5%; p<0,05), with a progressive increase in LVMI and LAVI (p<0,01). In evaluating the indicators of diastolic LV function, an increase in the indicators of active relaxation of the LV myocardium was observed, e’lateral, e’septal and their average value from 1 to 3 groups (p<0,01). When evaluating the performance brachial and central arterial pressure level brachial central pulsative arterial pressure in the three groups were not different (p>0,05). The analysis of SAP indices augmentation in the aorta showed a significant increase in AP and Alx 75 only patients in group 3 as compared with the other two groups, that noted as increase of PWV (as compared with those in groups 1 and 2; p<0,01). At the same time, the endothelial dependent vasodilation was already reduced in patients of group 2 from initial HF (compared with group 1 by 38,5%; p<0,01) in the absence of significant differences compared to patients with HF and E/e’ > 13 at rest (p>0,05). Patients of all groups were comparable in Ea (p>0,05). Patients in Group 2 have decrease Ees index compared with patients in Group 1 12,8% (p<0,01), which was accompanied by an increase Ea/Ees (21%; p<0,01). At the same time, in group 3, the values of both indicators did not differ from those in group 2 from the initial HF (p>0,05).

Conclusions.1. In patients with AH and HFpEF, compared with those without HF, a violation of the ventricular-arterial coupling is noted by reducing the final systolic stiffness of theLV. With an initial HF with an increase of left venricular pressure according to E/e’ > 13 only with exercice, these changes are accompanied by an increase in LVMI and LAVI by 7,7% and 5,1% and a moderate decrease in myocardial relaxation (e’ average by 23%).

2. The progression of heart failure with E/e’ > 13 at rest is not accompanied by subsequent modifications of ventricular–arterial coupling, but is associated with increased augmentation pulse wave, AP, Alx 75 and PWV and development of eccentric LV hypertrophy and a decrease in LV EF by 11,5%.

Keywords


heart failure; left ventricular ejection fraction; heart failure with preserved ejection fraction; left ventricular diastolic dysfunction; left ventricular filling pressure; ventricular–arterial coupling

References


an Heerebeek L, Borbely A, Niessen HW, Bronzwaer JG, van der Velden J, Stienen GJ, Linke WA, Laarman GJ, Paulus WJ. Myocardial structure and function differ in systolic and diastolic heart failure. Cirсulation. 2006;113:1966–1973https://doi.org/10.1161/CIRCULATIONAHA.105.587519

AHA Scientific Statement. Exercise standart for testing and training / G. F. Fletcher, G. J. Balady, A. Ezra // Cir. – 2001. – Vol. 4. – P. 1694–1740. https://doi.org/10.1161/hc3901.095960

ATS statement: guidelines for the six-minute walk test. Am J Respir Crit Care Med. 2002 Jul 1;166(1):111–7. https://doi.org/10.1164/ajrccm.166.1.at1102

Andreas J. Flammer, Todd Anderson, David S. Celermajer, Mark A. Creager, John Deanfield et al. The Assessment of Endothelial Function From Research into Clinical Practice. Circulation. 2012 August 7; 126(6):753–767. https://doi.org/10.1161/CIRCULATIONAHA.112.093245

Borlaug BA, Kass DA. Mechanisms of diastolic dysfunction in heart failure. Trends Cardiovasc Med. 2006 Nov;16(8):273–9. https://doi.org/10.1016/j.tcm.2006.05.003

Borlaug BA, Kass DA. Ventricular-vascular interaction in heart failure. Cardiol Clin. 2011 Aug;29(3):447–59. https://doi.org/10.1016/j.ccl.2011.06.004

Borlaug BA, Lam CS, Roger VL, Rodeheffer RJ, Redfield MM. Contractility and ventricular systolic stiffening in hypertensive heart disease insights into the pathogenesis of heart failure with preserved ejection fraction. J Am Coll Cardiol. 2009 Jul 28;54(5):410–8. https://doi.org/10.1016/j.jacc.2009.05.013

Borlaug BA, Olson TP, Lam CS, Flood KS, Lerman A, Johnson BD, Redfield MM. Global cardiovascular reserve dysfunction in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2010 Sep 7;56(11):845–54. https://doi.org/10.1016/j.jacc.2010.03.077

Borlaug B, Melenovsky V, Koepp K. Inhaled Sodium Nitrite Improves Rest and Exercise Hemodynamics in Heart Failure With Preserved Ejection Fraction. Circ Res. 2016 Sep 16;119(7):880–6. https://doi.org/10.1161/CIRCRESAHA.116.309184

Channer KS, Culling W, Wilde P, Jones JV. Estimation of left ventricular end-diastolic pressure by pulsed Doppler ultrasound. Lancet.1986 May 3;1(8488):1005–7 https://doi.org/10.1016/S0140-6736(86)91273-0

Chantler PD, Lakatta EG, Najjar SS. Arterial-ventricular coupling: mechanistic insights into cardiovascular performance at rest and during exercise. J Appl Physiol (1985). 2008 Oct;105(4):1342–51. https://doi.org/10.1152/japplphysiol.90600.2008

Chen CH, Nakayama M, Nevo E, et al. Coupled systolic-ventricular and vascular stiffening with age: implications for pressure regulation and cardiac reserve in the elderly. J Am Coll Cardiol.1998;32(5):1221–1227 https://doi.org/10.1016/S0735-1097(98)00374-X

Chirinos JA. Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 2): Clinical and Therapeutic Considerations. J Cardiovasc Transl Res. 2017 Jun;10(3):261–274. https://doi.org/10.1007/s12265-017-9736-2

Chirinos JA. Deep Phenotyping of Systemic Arterial Hemodynamics in HFpEF (Part 1): Physiologic and Technical Considerations. J Cardiovasc Transl Res. 2017 Jun;10(3):245–259. https://dx.doi.org/10.1007%2Fs12265-017-9735-3

Chirinos J, Zamani P. The Nitrate-Nitrite-NO Pathway and Its Implications for Heart Failure and Preserved Ejection Fraction. Curr Heart Fail Rep. 2016 Feb;13(1):47–59. https://doi.org/10.1007/s11897-016-0277-9

Gillebert TC, Leite-Moreira AF, De Hert SG. Load dependent diastolic dysfunction in heart failure. Heart Fail Rev. 2000 Dec;5(4):345–55. https://doi.org/10.1023/A:1026563313952

Claessens TE, Rietzschel ER, De Buyzere ML, De Bacquer D, De Backer G, Gillebert TC, Verdonck PR, Segers P. Noninvasive assessment of left ventricular and myocardial contractility in middle-aged men and women: disparate evolution above the age of 50? Am J Physiol Heart Circ Physiol. 2007 Feb;292(2):H856–65. https://doi.org/10.1152/ajpheart.00759.2006

Faconti L., Bruno R. M., Buralli S., Barzacchi M., Canto E. D., et al., Arterial–ventricular coupling and parameters of vascular stiffness in hypertensive patients: Role of gender. JRSM Cardiovasc Dis. 2017 Jan-Dec; 6. Published online 2017 Feb 1. https://dx.doi.org/10.1177%2F2048004017692277

Haykowsky MJ, Herrington DM, Brubaker PH, Morgan TM, Hundley WG, Kitzman DW. Relationship of flow-mediated arterial dilation and exercise capacity in older patients with heart failure and preserved ejection fraction. J Gerontol A Biol Sci Med Sci. 2013 Feb;68(2):161–7. Epub 2012 Apr 20. https://doi.org/10.1093/gerona/gls099

Hundley WG, Bayram E, Hamilton CA, Hamilton EA, Morgan TM, Darty SN, Stewart KP, Link KM, Herrington DM, Kitzman DW. Leg flow-mediated arterial dilation in elderly patients with heart failure and normal left ventricular ejection fraction. Am J Physiol Heart Circ Physiol. 2007 Mar;292(3):H1427–34. Epub 2006 Nov 3. https://doi.org/10.1152/ajpheart.00567.2006

Kawaguchi M, Hay I, Fetics B, Kass DA. Combined ventricular systolic and arterial stiffening in patients with heart failure and preserved ejection fraction: implications for systolic and diastolic reserve limitations. Circulation. 2003;107:714–720. https://doi.org/10.1161/01.CIR.0000048123.22359.A0

Kass DA, Kelly RP. Ventriculoarterial coupling: concepts, assumptions, and applications. Ann Biomed Eng 1992;20(1):41–62. http://dx.doi.org/10.1007/BF02368505

Karagodin I., Omer A,, Sparapani R,, Strande J. Aortic stiffening precedes onset of heart failure with preserved ejection fraction in patients with asymptomatic diastolic dysfunction. BMC Cardiovasc Disord. 2017;17:62. Published online 2017 Feb 14. https://dx.doi.org/10.1186%2Fs12872-017-0490-9

Kelly RP, Tunin R, Kass DA. Effect of reduced aortic compliance on cardiac efficiency and contractile function of in situ canine left ventricle. Circ Res. 1992;71:490–502. http://dx.doi.org/10.1161/01.RES.71.3.490

Kraigher-Krainer E, Shah AM, Gupta DK, Santos A1, Claggett B, et al. Impaired systolic function by strain imaging in heart failure with preserved ejection fraction. J Am Coll Cardiol. 2014 Feb 11;63(5):447–56. Epub 2013 Oct 30. https://doi.org/10.1016/j.jacc.2013.09.052

Ky B, French B, May Khan A, Plappert T, Wang A, Chirinos JA, et al. Ventricular-arterial coupling, remodeling, and prognosis in chronic heart failure. J Am Coll Cardiol. 2013 Sep 24;62(13):1165–72. https://doi.org/10.1016/j.jacc.2013.03.085

Kraigher-Krainer E, Shah AM, Gupta DK, et al. Impaired systolic function by strain imaging in heart failure with preserved ejection fraction. J Am Coll Cardiol 2014;63(5):447–56. https://doi.org/10.1016/j.jacc.2013.09.052

Laurent S, Cockcroft J, Van Bortel L, Boutouyrie P, Giannattasio C, et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications. Eur Heart J. 2006 Nov;27(21):2588–605. https://doi.org/10.1093/eurheartj/ehl254

Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015 Jan;28(1):1–39. https://doi.org/10.1016/j.echo.2014.10.003

Lam CS, Roger VL, Rodeheffer RJ, Bursi F, Borlaug BA, Ommen SR, Kass DA, Redfield MM. Cardiac structure and ventricular-vascular function in persons with heart failure and preserved ejection fraction from Olmsted County, Minnesota. Circulation. 2007 Apr 17;115(15):1982–90. Epub 2007 Apr 2 https://doi.org/10.1161/CIRCULATIONAHA.106.659763

Leite-Moreira AF, Correia-Pinto J, Gillebert TC. Afterload induced changes in myocardial relaxation: a mechanism for diastolic dysfunction. Cardiovasc Res. 1999;43:344–353. http://dx.doi.org/10.1016/S0008-6363(99)00099-1

Melenovsky V, Borlaug B, Rosen B, Hay I, Ferrucci L, Morell C, Lakatta E, Najjar S, Kass D. Cardiovascular features of heart failure with preserved ejection fraction versus non-failing hypertensive left ventricular hypertrophy in the urban Baltimore community. J Am Coll Cardiol. 2007;49(2):198–207 https://doi.org/10.1016/j.jacc.2006.08.050

Nagueh S.F., Smiseth O.A., Appleton C.P., et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2016;17(12):1321–60 Epub 2017 Oct 27. https://doi.org/10.1093/ehjci/jew082

Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM. Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med. 2006;355:251–259 https://doi.org/10.1056/NEJMoa052256

Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JG, Coats AJ, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GM, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European Heart Journal. 2016;37(27): 2129–2200 https://doi.org/10.1093/eurheartj/ehw128

Prasad A, Hastings JL, Shibata S, et al. Characterization of static and dynamic left ventricular diastolic function in patients with heart failure with a preserved ejection fraction. Circ Heart Fail 2010;3:617–26. https://doi.org/10.1161/CIRCHEARTFAILURE.109.867044

Sorajja P, Borlaug BA, Dimas VV, et al. SCAI/HFSA clinical expert consensus document on the use of invasive hemodynamics for the diagnosis and management of cardiovascular disease. Catheter Cardiovasc Interv. 2017;89:E233–E247. https://doi.org/10.1002/ccd.26888

Shah AM, Claggett B, Sweitzer NK, et al. Prognostic importance of impaired systolic function in heart failure with preserved ejection fraction and the impact of spironolactone. Circulation 2015;132:402–14. https://doi.org/10.1161/CIRCULATIONAHA.115.015884

Townsend RR, Wilkinson IB, Schiffrin EL, Avolio AP, Chirinos JA, et al. American Heart Association Council on Hypertension. Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association. Hypertension. 2015 Sep;66(3):698–722. Epub 2015 Jul 9. https://doi.org/10.1161/HYP.0000000000000033

Wilson JR, Rayos G, Yeoh TK, et al. Dissociation between exertional symptoms and circulatory function in patients with heart failure. Circulation. 1995;92:47–53. http://dx.doi.org/10.1161/01.CIR.92.1.47

Zamani P, Rawat D, Shiva-Kumar P, Geraci S, Bhuva R, et al. Effect of inorganic nitrate on exercise capacity in heart failure with preserved ejection fraction. Circulation. 2015 Jan 27;131(4):371–80; discussion 380. Epub 2014 Dec 22. https://doi.org/10.1161/CIRCULATIONAHA.114.012957




Copyright (c) 2020 К. М. Амосова, О. В. Василенко, Ю. В. Руденко, А. Б. Безродний, Г. В. Мостбауер, К. І. Черняєва, І. В. Прудкий, Н. В. Шишкіна, Ю. О. Сиченко, А. В. Саблін, Д. М. Сербін, Б. В. Гуськов, Н. В. Мельніченко

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

ISSN 2412-8708 (Online), ISSN 2307-5112 (Print)

Flag Counter

ISSN (print): 2307-5112.