Key result
Both increased brachial-ankle pulse wave velocity and electrocardiography-determined left ventricular hypertrophy were independently associated with left ventricular diastolic dysfunction (OR 1.02 and 3.53, respectively).
Why the study?
Are increased arterial stiffness (baPWV) and ECG-determined LVH independently associated with left ventricular diastolic dysfunction?
Cross-Sectional (n=270)
No
Are increased arterial stiffness (baPWV) and ECG-determined LVH independently associated with left ventricular diastolic dysfunction?
Odds Ratio: 3.53 (95% CI 1.3–9.55)
Absolute Event Rate: 95.2% vs 34.9%
p-value: p=0.013
Increased arterial stiffness and ECG-determined left ventricular hypertrophy are independently associated with left ventricular diastolic dysfunction, suggesting their utility as simple tools to identify high-risk patients.
May aid risk stratification for diastolic dysfunction; hypothesis-generating and should not yet change practice.
OBJECTIVES: Increased arterial stiffness is associated with left ventricular diastolic dysfunction (LVDD), but this association may be influenced by left ventricular (LV) performance. Left ventricular hypertrophy (LVH) is not only a significant determinant of LV performance, but is also correlated with LVDD. This study is designed to compare LV diastolic function among patients divided by brachial-ankle pulse wave velocity (baPWV) and electrocardiography (ECG)-determined LVH and to assess whether increased baPWV and ECG-determined LVH are independently associated with LVDD. METHODS: This cross-sectional study enrolled 270 patients and classified them into four groups according to the median value of baPWV and with/without ECG-determined LVH. The baPWV was measured using an ABI-form device. ECG-determined LVH was defined by Sokolow-Lyon criterion. LVDD was defined as impaired relaxation, pseudonormal, and restrictive mitral inflow patterns. Groups 1, 2, 3, and 4 were patients with lower baPWV and without ECG-determined LVH, lower baPWV but with ECG-determined LVH, higher baPWV but without ECG-determined LVH, and higher baPWV and with ECG-determined LVH respectively. RESULTS: Early diastolic mitral velocity (Ea) was gradually decreased from group 1 to group 4 (p≦0.027). Patients in group 4 had the highest prevalence of LVDD (all p<0.001). After multivariate analysis, both baPWV and ECG-determined LVH were independent determinants of Ea (β = -0.02, P<0.001; β = -1.77, P<0.001 respectively) and LVDD (odds ratio = 1.02, P = 0.011 and odds ratio = 3.53, P = 0.013 respectively). CONCLUSION: Our study showed the group with higher baPWV and ECG-determined LVH had the lowest Ea and highest prevalence of LVDD. In addition, both baPWV and ECG-determined LVH were independently associated with Ea and LVDD. Hence, assessment of arterial stiffness by baPWV and LVH by ECG may be useful in identifying the high risk group of LVDD.
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Hsu et al. (2012) conducted a cross-sectional in Left Ventricular Diastolic Dysfunction (n=270). Electrocardiography-determined left ventricular hypertrophy vs. Absence of electrocardiography-determined left ventricular hypertrophy was evaluated on Left ventricular diastolic dysfunction (LVDD) (OR 3.53, 95% CI 1.30-9.55, p=0.013). Both increased brachial-ankle pulse wave velocity and electrocardiography-determined left ventricular hypertrophy were independently associated with left ventricular diastolic dysfunction (OR 1.02 and 3.53, respectively).
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