Relationship between increased arterial stiffness and mild left ventricle diastolic dysfunction in asymptomatic subjects with cardiovascular risk factors

Purpose: We aimed to identify whether an increased arterial stiffness (AS) coulb be an independent determinant of mild left ventricle (LV) diastolic dysfunction in asymptomatic subjects with cardiovascular risk factors (CVRF). Methods: 140 subjects (mean age= 52+18 years) with CVRF underwent a complete echocardiographic and carotid ultrasonographic examination using a system (Aloka a-10), provided with a software for evaluation of the AS parameters. All the following parameters were calculated: b (arterial stiffness parameter), AI (augmentation index), PWV (pulse wave velocity), AI (arterial compliance) and Ep (elastic modulus). Carotid intima media-thickness (IMT) was also measured. Diastolic function was evaluated by PW Doppler mitral inflow parameters and Tissue Doppler Imaging of septal annulus. Results: 44 (mean age= 65+11) out of 140 patients (Group 1) showed a grade I diastolic dysfunction, defined as E/A , 0.8, mitral deceleration time (DT) . 240 ms and E’ , 8 cm/sec, whereas the remaining 96 (mean age=45+16) had a normal diastolic function (Group 0). Comparing the 2 groups, AS was increased in Group 1 compared to Group 0 (PWV=8+2 vs. 6+2, p,0.001; b=13+5 vs. 8+5, p,0.001 and Ep=190+80 vs. 112+70, p,0.001, respectively in the 2 groups). Univariate analysis showed that PWV showed a significant correlation with diastolic function parameters: E wave velocity (p ,0.001), E/A (p = ,0.001), E’ (p ,0.001) and DT (p = 0.005) as well as with age (p,0.001), hypertension (p,0.001), diabetes (p,0.001), dyslipidemia (p,0001), smoking (p,0.001), systolic and diastolic BP (p,0.001), LV mass (p,0.001)and IMT (p,0.001). On multivariate linear regression analysis, age (p=0.01) and PWV (p=0.03) were the only independent determinants of I degree diastolic dysfunction. Furthermore, ROC analysis showed that age and PWV had the highest AUC in respect to LV mass and carotid IMT (AUC 0.82, p,0.001 and 0.81, p,0.001 for age and PWV respectively) for predicting a I degree diastolic dysfunction. Conclusions: Up to date, grade I LV diastolic dysfunction in asymptomatic subjects gained a limited importance in the decision making in clinical practice or prevention programs. Interestingly, establishing a link between arterial stiffness and mild diastolic dysfunction independent of the age, may be helpful in guiding clinician for a more tailored patient risk stratification and medical treatment.