Key result
Severe left ventricular systolic dysfunction was associated with a lower augmentation index compared to moderate dysfunction.
Why the study?
How does the degree of left ventricular systolic dysfunction affect arterial wave reflections and ventricular-vascular interaction in patients with chronic heart failure?
Observational (n=52)
No
How does the degree of left ventricular systolic dysfunction affect arterial wave reflections and ventricular-vascular interaction in patients with chronic heart failure?
In patients with severe left ventricular systolic dysfunction (LVEF ≤ 30%), aortic wave reflections negatively interfere with LV function and induce a shortening of ejection duration, whereas wave reflections in moderate LVSD are similar to healthy controls.
Answers are grounded in this paper and cite their sources.
Lower AIx in severe LVSD may indicate altered ventricular-vascular interaction; hypothesis-generating and should not change practice.
Central aortic pressure waveform (AoPW) is the summation of a forward-traveling wave generated by the left ventricle and a backward-traveling wave caused by the reflection of the forward wave. The aim of this study was to evaluate the effect of ventricular-vascular coupling on the morphology of AoPW in chronic heart failure patients with different degrees of left ventricular systolic dysfunction (LVSD) using pulse wave analysis (PWA). PWA of AoPW and left ventricular (LV) function were evaluated by applanation tonometry in 26 control subjects, in 12 patients with left ventricular ejection fraction (LVEF) ≤ 30%, and in 14 patients with LVEF > 30%. Augmentation pressure, augmentation index, wasted energy, and ejection duration were lower in patients with LVEF ≤ 30% than in those with LVEF > 30% and in control subjects. Furthermore, augmentation index showed an inverse correlation with Doppler mitral E-wave amplitude (r = -0.40; P = 0.04) and E/A ratio (r = -0.42; P = 0.03) and a direct correlation with deceleration time of mitral E-waves (r = 0.39; P = 0.04). In patients with severe LVSD (LVEF ≤ 30%), aortic wave reflections negatively interfere with LV function and induce a shortening of ejection duration. In contrast, AoPW is similar in patients with moderate LVSD (LVEF > 30%) and in control subjects.
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Paglia et al. (2014) conducted an observational in Left ventricular systolic dysfunction (n=52). Severe left ventricular systolic dysfunction (LVEF ≤ 30%) vs. Moderate left ventricular systolic dysfunction (LVEF > 30%) was evaluated on Augmentation index (AIx) (p=<0.05). Severe left ventricular systolic dysfunction was associated with a lower augmentation index compared to moderate dysfunction.
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