Arterial Stiffness Is Associated With Left Ventricular Diastolic Function in Patients With Cardiovascular Risk Factors: Early Detection With the Use of Cardio-Ankle Vascular Index and Ultrasonic Strain Imaging

doi:10.1016/j.cardfail.2007.05.010

Journal of Cardiac Failure

Volume 13, Issue 9, November 2007, Pages 744-751

https://doi.org/10.1016/j.cardfail.2007.05.010 Get rights and content

Abstract

Background

It is well known that left ventricular (LV) diastolic function declines in the elderly, especially in patients with cardiovascular risk factors. However, few data are available on the early detection of relationship between arterial stiffness and LV diastolic dysfunction.

Methods and Results

The common carotid artery intima-media thickness (IMT) and cardio-ankle vascular index (CAVI) were measured to determine the presence of subclinical atherosclerosis in 30 patients (13 men and 17 women; mean age 59 ± 5.7 years) with 1 or more cardiovascular risk factors. LV systolic and diastolic function also were determined by measuring transmitral flow velocity, mitral annular motion velocity, and myocardial strain and strain rate profiles using pulsed Doppler, tissue velocity, and ultrasonic strain imaging. The CAVI correlated with the peak early diastolic velocity of transmitral flow velocity (r = −0.50, P < .01), the ratio of peak early to late diastolic transmitral flow velocity (r = −0.37, P < .05), the deceleration time from peak to baseline of the early diastolic transmitral flow velocity (r = 0.57, P < .01), the peak early diastolic mitral annular motion velocity (r = −0.41, P < .05), and the peak early diastolic strain rates at the endocardial sites of the LV posterior and inferior walls (r = 0.61, P < .001; r = 0.56, P < .001, respectively). There were no relationships between CAVI and LV ejection fraction, peak systolic mitral annular motion velocity, or peak systolic strain rates of the LV walls. Multiple regression analysis revealed that the early diastolic strain rates at the endocardial sites of the LV walls are strongly correlated with CAVI. There were no relationships between the IMT and the LV systolic and diastolic parameters.

Conclusion

These results suggest that cardiovascular risk factors interact to affect arterial stiffness and LV relaxation, and therefore support the importance of screening using CAVI and ultrasonic strain imaging and early intervention in this patient population.

Section snippets

Study Population

We recruited 30 consecutive patients with 1 or more cardiovascular risk factor (13 men, 17 women; mean age: 59 ± 6 years) who visited our hospital between 2005 and 2006. The patients were enrolled in this study because they met 1 or more of the following criteria: 1) current smoker, 2) body mass index ≥25 kg/m², 3) use of antihypertensive therapy, 4) use of lipid-lowering therapy, or 5) prediabetic or diabetic patients receiving diet or oral hypoglycemic therapy.

Patients with clinically

Clinical Characteristics

The clinical characteristics of the subjects are summarized in Table 1. The patients had 1 or more cardiovascular risk factors: 1) current smoker (>20 cigarettes for 10 or more years, 7 patients), 2) body mass index ≥ 25 kg/m² (14 patients), 3) use of antihypertensive therapy (systolic blood pressure: 135 ± 13 mm Hg, diastolic blood pressure: 82 ± 7 mm Hg, 10 patients), 4) use of lipid-lowering therapy (total cholesterol: 203 ± 17 mg/dL, fasting triglycerides: 104 ± 33 mg/dL, 7 patients), or 5)

Discussion

Many studies have demonstrated that not only metabolic syndrome but also hypertension, obesity, diabetes, and hyperlipidemia are individual independent risk factors of cardiovascular disease.1, 2, 13, 14, 15 On the other hand, it is known that LV diastolic dysfunction also increases in the elderly population, especially in patients with cardiovascular risk factors.

In the routine clinical setting, carotid arterial lesions can be detected easily by high-resolution B-mode ultrasonography.¹¹ In

Conclusion

The present study indicates that combined analysis of CAVI and ultrasonic strain imaging appears to be feasible for detecting sensitively the relationship between arterial stiffness and LV relaxation in its early stages in patients with cardiovascular risk factors.

References (40)

P.J. Miranda et al.
Metabolic syndrome: evaluation of pathological and therapeutic outcomes
Am Heart J
(2005)
H. Tomiyama et al.
Influences of age and gender on results of noninvasive brachial-ankle pulse wave velocity measurement: a survey of 12517 subjects
Atherosclerosis
(2003)
A. Heimdal et al.
Real-time strain rate imaging of the left ventricle by ultrasound
J Am Soc Echocardiogr
(1998)
L.E. Sade et al.
Usefulness of angle corrected tissue Doppler to assess segmental left ventricular function during dobutamine stress echocardiography in patients with and without coronary artery disease
Am J Cardiol
(2005)
L.R. Peterson et al.
Alterations in left ventricular structure and function in young healthy obese women: assessment by echocardiography and tissue Doppler imaging
J Am Coll Cardiol
(2004)
A. Scuteri et al.
EG. Metabolic syndrome amplifies the age-associated increases in vascular thickness and stiffness
J Am Coll Cardiol
(2004)
L. de las Fuentes et al.
Plasma triglyceride level is an independent predictor of altered left ventricular relaxation
J Am Soc Echocardiogr
(2005)
S.S. Ahmed et al.
Preclinical abnormality of left ventricular function in diabetes mellitus
Am Heart J
(1975)
F.M. Fouad et al.
Left ventricular diastolic function in hypertension: relation to left ventricular mass and systolic function
J Am Coll Cardiol
(1984)
M. Alam et al.
Acute effects of smoking on diastolic function in healthy participants: studies by conventional Doppler echocardiography and Doppler tissue imaging
J Am Soc Echocardiogr
(2002)

T.E. Meyer et al.

Long-term caloric restriction ameliorates the decline in diastolic function in humans

J Am Coll Cardiol

(2006)

S. Ohtsuka et al.

Chronically decreased aortic distensibility causes deterioration of coronary perfusion during increased left ventricular contraction

J Am Coll Cardiol

(1994)

T. Oki et al.

Pulsed tissue Doppler imaging of left ventricular systolic and diastolic wall motion velocities to evaluate differences between long and short axes in healthy subjects

J Am Soc Echocardiogr

(1999)

P. Dandona et al.

Metabolic syndrome. A comprehensive perspective based on interactions between obesity, diabetes, and inflammation

Circulation

(2005)

K. Sutton-Tyrrell et al.

Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults

Circulation

(2005)

R. Asmar et al.

Assessment of arterial distensibility by automatic pulse wave velocity measurement: validation and clinical application studies

Hypertension

(1995)

T. Yambe et al.

Cardio-ankle vascular index (CAVI) for the monitoring of the atherosclerosis after heart transplantation

Biomed Pharmacother

(2005)

T. Kubozono et al.

Clinical significance and reproducibility of new arterial distensibility index

Circ J

(2007)

K. Shirai et al.

A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI)

J Atheroscler Thromb

(2006)

T. Oki et al.

Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation

Am J Cardiol

(1997)

Cited by (61)

Arterial stiffness and atherosclerosis: mechanistic and pathophysiologic interactions
2022, Textbook of Arterial Stiffness and Pulsatile Hemodynamics in Health and Disease
There are significant mechanistic and pathophysiologic interactions between arterial stiffness, atherosclerosis, and hemodynamic stress. Atherosclerosis is triggered by endothelial cell dysfunction. Subsequent lipid accumulation and increased inflammation facilitate the formation of pathological vulnerable plaques. This results in the development of atherosclerotic cardiovascular disease. In contrast, arterial stiffness results from elastin breakdown, wall calcification, fibrosis, collagen, and elastin cross-linking, increased vascular smooth muscle cell tone, and endothelial cell dysfunction. Both these types of vascular failure share pathophysiological mechanisms, involving aging, inflammation, and metabolic and hemodynamic risk factors. In addition, both are important contributors to cardiovascular risk. The systemic hemodynamic atherosclerotic syndrome has been proposed as a novel clinical entity linking arterial stiffness, atherosclerosis, and hemodynamic stress, ultimately contributing to target organ damage and cardiovascular events.
Effects of long-term air pollution exposure on ankle-brachial index and cardio-ankle vascular index: A longitudinal cohort study using data from the Electricity Generating Authority of Thailand study
2021, International Journal of Hygiene and Environmental Health
Citation Excerpt :
Since CAVI is calculated from heart-ankle PWV, it is theoretically independent of blood pressure at the time of measurement (Asmar, 2017; Miyoshi and Ito, 2016; Shirai et al., 2011; Sun, 2013; Yambe et al., 2004) and may thus serve as a better predictor of arterial stiffness (Takaki et al., 2007). Previous studies have also suggested CAVI to be a useful long-term predictor of CVD risk (Mizuguchi et al., 2007; Nakamura et al., 2008; Yingchoncharoen et al., 2012). High CAVI was associated with coronary artery disease (CAD), cerebral artery disease, and chronic kidney disease (Asmar, 2017).
Ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) are surrogate measures of atherosclerosis based on the functional performance of vessels, and are highly related to cardiovascular events. However, only a few longitudinal studies have been conducted on their associations with long-term air pollution exposure.
This study aimed to examine whether long-term air pollution exposure is associated with ABI and CAVI in workers of the Electricity Generating Authority of Thailand (EGAT) in the Bangkok Metropolitan Region (BMR).
This longitudinal study included 1261 participants (age range, 57–76 years as of 2007) of the EGAT study (2007–2017). ABI and CAVI were measured in 2007, 2012, and 2017. Annual mean concentrations of particulate matter ≤10 μm in diameter (PM₁₀), sulfur dioxide (SO₂), nitrogen dioxide (NO₂), ozone (O₃), and carbon monoxide (CO) were estimated by ordinary kriging using data from 22 background and 7 traffic monitoring stations in BMR between 2002 and 2017. Linear mixed-effects models were used to assess associations between air pollution (expressed as 1-year, 3-year, and 5-year average concentration) and ABI and CAVI (expressed as percent changes per interquartile range (IQR) increase in PM₁₀, O₃, NO₂, SO_2, and CO). We also applied the mixed-effect ordinal logistic models to calculate odds ratios (ORs) of having high or moderate CAVI per an IQR increase in air pollution.
After controlling for potential confounders, 1-year average CO was negatively associated with ABI, but not significantly (−0.48%, 95% CI: −1.03, 0.07). Three-year average NO₂ was positively associated with CAVI (6.67%, 95% CI: 0.21, 13.1). In contrast, 1-year average PM₁₀ was inversely associated with CAVI although the association was not significant. Although not significantly, 1-year average NO₂ and CO were positively associated with prevalence of high or moderate CAVI.
Although not statistically significant, long-term NO₂ and CO exposure was associated with ABI and CAVI in the participants of the EGAT study.
Correlation of Arterial Stiffness With Left Atrial Volume Index and Left Ventricular Mass Index in Young Adults: Evaluation by Coronary Computed Tomography Angiography
2019, Heart Lung and Circulation
Citation Excerpt :
The CAVI is also a surrogate marker of atherosclerotic disease [2–4]. Previous studies have shown that the CAVI has a close association with left ventricular (LV) diastolic function [2,5–7]. Arterial stiffening and subsequent increased stiffness or noncompliance of the left ventricle following LV diastolic dysfunction is associated with left atrial (LA) enlargement [8,9] and increased LV mass [10].
Increased arterial stiffness is reportedly associated with cardiac remodelling, including the left atrium and left ventricle, in middle-aged and older adults. However, little is known about this association in young adults.
In total, 73 patients (44 (60%) men) aged 25 to 45 years with suspected coronary artery disease were included in the analysis. The left atrial volume index (LAVI), left ventricular volume index (LVVI), and left ventricular mass index (LVMI) were measured using coronary computed tomography angiography (CCTA). Arterial stiffness was assessed with the cardio-ankle vascular index (CAVI). An abnormally high CAVI was defined as that above the age- and sex-specific cut-off points of the CAVI.
Compared with patients with a normal CAVI, those with an abnormally high CAVI were older and had a greater prevalence of diabetes mellitus, higher diastolic blood pressure, greater coronary artery calcification score, and a greater LAVI (33.5 ± 10.3 vs. 43.0 ± 10.3 mL/m², p < 0.01). In contrast, there were no significant differences in the LVVI or LVMI between the subgroups with a normal CAVI and an abnormally high CAVI. Multivariate linear regression analysis showed that the LAVI was significantly associated with an abnormally high CAVI (standardised regression coefficient = 0.283, p = 0.03).
The present study demonstrated that increased arterial stiffness is associated with the LAVI, which reflects the early stages of cardiac remodelling, independent of various comorbidity factors in young adults with suspected coronary artery disease.
Cardio-ankle vascular index predicts for the incidence of cardiovascular events in obese patients: A multicenter prospective cohort study (Japan Obesity and Metabolic Syndrome Study: JOMS)
2015, Atherosclerosis
Citation Excerpt :
In the multi-centered Japan Obesity and Metabolic Syndrome Study (JOMS), we recently reported that CAVI is less influenced by BP and more closely correlated than PWV with the severity of MetS, hypoadiponectinemia and efficacy of weight reduction, and suggested that CAVI is useful to evaluate atherogenic risks in obese patients [14]. Importantly, CAVI has more significant correlations with the left ventricular diastolic function, number of stenotic coronary vessels, and severity of coronary atherosclerosis than the intima-media thickness (IMT) and plaque score [15,16]. However, there has been no large population-based prospective study on the usefulness of CAVI as a predictor of CVD in obese patients.
The cardio-ankle vascular index (CAVI) is an index of arterial stiffness less dependent on blood pressure and an indicator suitable for assessing the arterial dysfunction. However, it remains unclear whether CAVI can predict the outcome of cardiovascular diseases (CVD) in obese patients.
A total of 425 obese Japanese outpatients (189 men and 236 women, mean age: 51.5 years) were enrolled in a multicenter prospective cohort Japan, the Japan Obesity and Metabolic Syndrome Study (JOMS). Primary analysis regarding measurements of cardiovascular risk factors including CAVI and the occurrence of macrovascular complications was based on following the participants over a 5-year period.
Of the eligible patients, 300 (78%) were followed into the fifth year. During the study period, 15 coronary heart disease, 7 stroke, and 6 arteriosclerosis obliterans events occurred. All events occurred in 28 patients, and CVD incidence rate was 15.8 per 1000 person-years. In the analysis of adjusted models for traditional risk factors, CAVI was a significant factor for the incidence of events. In addition, high CAVI and low HDL-cholesterol were significant factors for the incidence of events in Cox stepwise multivariate analysis when age- and sex-adjusted (CAVI [per 1]: HR = 1.44 [1.02–2.02], p = 0.037; HDL-cholesterol [per 1 mmol/L]: HR = 0.20 [0.06–0.69], p = 0.011). In addition, CAVI added value to atherosclerotic cardiovascular disease risk score in predicting the development of CVD.
This study demonstrates for the first time that CAVI is an effective predictor of CVD events in obese patients.
Cardio-Vascular Interaction Evaluated by Speckle-Tracking Echocardiography and Cardio-Ankle Vascular Index in Hypertensive Patients
2022, International Journal of Molecular Sciences
Clinical Applications Measuring Arterial Stiffness: An Expert Consensus for the Application of Cardio-Ankle Vascular Index
2022, American Journal of Hypertension

View all citing articles on Scopus

View full text

Clinical InvestigationArterial Stiffness Is Associated With Left Ventricular Diastolic Function in Patients With Cardiovascular Risk Factors: Early Detection With the Use of Cardio-Ankle Vascular Index and Ultrasonic Strain Imaging

Abstract

Background

Methods and Results

Conclusion

Section snippets

Study Population

Clinical Characteristics

Discussion

Conclusion

Am Heart J

Atherosclerosis

J Am Soc Echocardiogr

Am J Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

Am Heart J

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Coll Cardiol

J Am Soc Echocardiogr

Metabolic syndrome. A comprehensive perspective based on interactions between obesity, diabetes, and inflammation

Circulation

Elevated aortic pulse wave velocity, a marker of arterial stiffness, predicts cardiovascular events in well-functioning older adults

Circulation

Assessment of arterial distensibility by automatic pulse wave velocity measurement: validation and clinical application studies

Hypertension

Cardio-ankle vascular index (CAVI) for the monitoring of the atherosclerosis after heart transplantation

Biomed Pharmacother

Clinical significance and reproducibility of new arterial distensibility index

Circ J

A novel blood pressure-independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI)

J Atheroscler Thromb

Clinical application of pulsed Doppler tissue imaging for assessing abnormal left ventricular relaxation

Am J Cardiol

Clinical Investigation
Arterial Stiffness Is Associated With Left Ventricular Diastolic Function in Patients With Cardiovascular Risk Factors: Early Detection With the Use of Cardio-Ankle Vascular Index and Ultrasonic Strain Imaging