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Okada K, Nakabachi M, Hayashi Y, Shinagawa M, Yoshikawa A, Tsujita K, Sakamoto Y. Optimal left ventricular diameter measurement in subjects with sigmoid septum: comparison with three-dimensional left ventricular volume. J Echocardiogr 2024; 22:41-47. [PMID: 37735324 DOI: 10.1007/s12574-023-00626-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND The purpose of this study was to determine the most appropriate measurement of left ventricular (LV) end-diastolic diameter for subjects with the sigmoid septum (SS) by measuring the LV end-diastolic diameter at the base and mid-ventricle and by examining the relationship between these measurements and the three-dimensional (3D) echocardiographic LV end-diastolic volume. METHODS In 91 patients who underwent echocardiography for screening cardiovascular abnormalities, the aorto-septal angle (ASA) was measured as an index of the sigmoid septum. LV end-diastolic diameter was measured at the base and mid-ventricular level (DDbase and DDmid, respectively), and their average value was calculated (DDavg). By using 3D echocardiography, LV end-diastolic volume (EDV3D) was measured. RESULTS Among 91 patients, 48 patients had narrow ASA (< 120 degrees) and were divided into the sigmoid septum (SS) group, and the remaining 43 patients were divided into the non-SS group. In the SS group, all DDbase, DDmid, and DDavg were significantly correlated with EDV3D (r = 0.59, 0.80, and 0.76, respectively), and the correlation coefficient between DDbase and EDV3D was significantly lower than that between DDmid and EDV3D (p < 0.01). On the other hand, in the non-SS group, all DDbase, DDmid, and DDavg were significantly correlated with EDV3D (r = 0.77, 0.85, and 0.84, respectively), and the correlation coefficient between DDbase and EDV3D was statistically comparable to that between DDmid and EDV3D (p = 0.12). ASA was significantly correlated with the difference of DDmid minus DDbase (r = - 0.71, p < 0.001). CONCLUSIONS In patients with SS, DDmid and DDavg were well reflected the 3D echocardiographic LV end-diastolic volume.
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Affiliation(s)
- Kazunori Okada
- Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Japan Healthcare University, Tsukisamu Higashi 3-Jo 11-1-50, Toyohira-Ku, Sapporo, 062-0053, Japan.
| | - Masahiro Nakabachi
- Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Japan Healthcare University, Tsukisamu Higashi 3-Jo 11-1-50, Toyohira-Ku, Sapporo, 062-0053, Japan
| | - Yasuhiro Hayashi
- Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Japan Healthcare University, Tsukisamu Higashi 3-Jo 11-1-50, Toyohira-Ku, Sapporo, 062-0053, Japan
| | - Masaaki Shinagawa
- Department of Clinical Laboratory Sciences, Faculty of Health Sciences, Japan Healthcare University, Tsukisamu Higashi 3-Jo 11-1-50, Toyohira-Ku, Sapporo, 062-0053, Japan
| | - Ayaka Yoshikawa
- Kitanodai Clinic, Medical Corporation Hokuseki Group, Kitahiroshima, Japan
| | - Kosuke Tsujita
- Kitanodai Clinic, Medical Corporation Hokuseki Group, Kitahiroshima, Japan
| | - Yoichi Sakamoto
- Kitanodai Clinic, Medical Corporation Hokuseki Group, Kitahiroshima, Japan
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Nakayama T, Yamamoto J, Ozeki T, Tokoroyama S, Mori Y, Hori M, Tsujita M, Shirasawa Y, Takeda A, Kondo C, Murata M, Suzuki S, Kinoshita Y, Fukuda M, Ueki T, Ikehara N, Sugiura M, Goto T, Hashimoto H, Yajima K, Maruyama S, Koyama H, Morozumi K, Seo Y. Impact of an angulated aorto-septal relationship on cardio-cerebrovascular outcomes in patients undergoing hemodialysis. PLoS One 2024; 19:e0298637. [PMID: 38394305 PMCID: PMC10890729 DOI: 10.1371/journal.pone.0298637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024] Open
Abstract
Aortic and valvular calcification are well-known risk factors for cardio-cerebrovascular events in patients undergoing hemodialysis. We investigated the clinical impact of an angulated aorto-septal angle as a result of aortic elongation due to aortic calcification on cardio-cerebrovascular outcomes in patients undergoing hemodialysis. We investigated 306 patients (mean age 65.4 years, 68% male) who underwent pre-scheduled routine echocardiography between April and September 2018. The angle between the anterior wall of the aorta and the ventricular septal surface (ASA) was quantified. We determined aortic and mitral valve calcification scores based on calcified cardiac changes; the aortic and mitral valve scores ranged between 0-9 and 0-6, respectively. The primary endpoint was a composite including cardio-cerebrovascular events and cardio-cerebrovascular death. The mean duration of dialysis among the patients in this analysis was 9.6 years. The primary endpoint was observed in 54 patients during the observational period (median 1095 days). Multivariable Cox proportional hazards analyses identified left ventricular ejection fraction (per 10% increase: hazard ratio [HR] 0.67; 95% confidential interval [CI] 0.53-0.84, P = 0.001), left ventricular mass index (per 10 g/m2 increase: HR 1.14; 95% CI 1.05-1.24, P = 0.001), ASA (per 10 degree increase: HR 0.69; 95% CI 0.54-0.88; P = 0.003), and aortic valve calcification score (HR 1.15; 95% CI 1.04-1.26, P = 0.005) as independent determinants of the primary endpoint. Kaplan-Meier analysis showed a higher incidence of the primary endpoint in patients with ASA <119.4 degrees than those with ASA ≥119.4 degrees (Log-rank P < 0.001). An angulated aorto-septal angle is an independent risk factor for cardio-cerebrovascular events and cardio-cerebrovascular death in patients undergoing hemodialysis.
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Affiliation(s)
- Takafumi Nakayama
- Department of Cardiology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
- Department of Cardiology, Nagoya City University West Medical Center, Nagoya, Aichi, Japan
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Junki Yamamoto
- Department of Cardiology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Toshikazu Ozeki
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | | | - Yoshiko Mori
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Mayuko Hori
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Makoto Tsujita
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Yuichi Shirasawa
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Asami Takeda
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Chika Kondo
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Minako Murata
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Shigeru Suzuki
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Yuko Kinoshita
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Michio Fukuda
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Tsuneo Ueki
- Department of Urology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Noriyuki Ikehara
- Department of Cardiology, Nagoya City University West Medical Center, Nagoya, Aichi, Japan
| | - Masato Sugiura
- Department of Cardiology, Nagoya City University West Medical Center, Nagoya, Aichi, Japan
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | - Hiroya Hashimoto
- Clinical Research Management Center, Nagoya City University Hospital, Nagoya, Aichi, Japan
| | - Kazuhiro Yajima
- Department of Cardiology, Nagoya City University West Medical Center, Nagoya, Aichi, Japan
| | - Shoichi Maruyama
- Department of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Hiroichi Koyama
- Department of General Medicine, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Kunio Morozumi
- Department of Nephrology, Masuko Memorial Hospital, Nagoya, Aichi, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
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Gao L, Ma W, Li M, Yang Y, Qi L, Zhang B, Wang C, Zhang Y, Huo Y. Association between basal septal hypertrophy and left ventricular geometry in a community population. BMC Cardiovasc Disord 2022; 22:579. [PMID: 36587201 PMCID: PMC9805678 DOI: 10.1186/s12872-022-03004-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 12/12/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Left ventricular (LV) geometry is closely associated with cardiovascular disease; however, few studies have evaluated the relationship between basal septal hypertrophy (BSH) and LV geometry. In this study, we examined the relationship between BSH and LV geometry in a Beijing community population. METHODS The clinical and echocardiographic data of 1032 participants from a community in Beijing were analyzed. BSH was defined as a basal interventricular septal thickness ≥ 14 mm and a basal septal thickness/mid-septal thickness ≥ 1.3. On the basis of their echocardiographic characteristics, patients were described as having a normal geometry, concentric remodeling, concentric hypertrophy, or eccentric hypertrophy. Multivariable logistic regression was used to analyze the relationship between BSH, LV mass index (LVMI), and relative wall thickness (RWT). RESULTS The prevalence of BSH was 7.4% (95% confidence interval [CI] 5.8-9.0%). Basal and middle interventricular septal thickness, LV posterior wall thickness, and RWT were greater, while LVMI and LV end-diastolic dimension were lower in the BSH group than in the non-BSH group (p < 0.05). The BSH group accounted for the highest proportion of patients with concentric remodeling. A multivariable regression analysis showed that BSH increased by 3.99-times (odds ratio [OR] 3.99, 95% CI 2.05-7.78, p < 0.01) when RWT was > 0.42, but not when LVMI increased (OR 0.16, 95% CI 0.02-1.19, p = 0.07). There were no interactions between BSH and age, body mass index, sex, diabetes mellitus, coronary heart disease, stroke, and smoking in relation to an RWT > 0.42. CONCLUSION BSH was independently associated with an RWT > 0.42.
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Affiliation(s)
- Lan Gao
- grid.411472.50000 0004 1764 1621Division of Cardiology, Department of Cardiovascular Disease, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing, 100034 China ,grid.411472.50000 0004 1764 1621Echocardiography Core Lab, Institute of Cardiovascular Disease at Peking University First Hospital, Beijing, China
| | - Wei Ma
- grid.411472.50000 0004 1764 1621Division of Cardiology, Department of Cardiovascular Disease, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing, 100034 China ,grid.411472.50000 0004 1764 1621Echocardiography Core Lab, Institute of Cardiovascular Disease at Peking University First Hospital, Beijing, China
| | - Min Li
- grid.411472.50000 0004 1764 1621Division of Cardiology, Department of Cardiovascular Disease, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing, 100034 China
| | - Ying Yang
- grid.411472.50000 0004 1764 1621Division of Cardiology, Department of Cardiovascular Disease, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing, 100034 China ,grid.411472.50000 0004 1764 1621Echocardiography Core Lab, Institute of Cardiovascular Disease at Peking University First Hospital, Beijing, China
| | - Litong Qi
- grid.411472.50000 0004 1764 1621Division of Cardiology, Department of Cardiovascular Disease, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing, 100034 China ,grid.411472.50000 0004 1764 1621Echocardiography Core Lab, Institute of Cardiovascular Disease at Peking University First Hospital, Beijing, China
| | - Baowei Zhang
- grid.411472.50000 0004 1764 1621Division of Cardiology, Department of Cardiovascular Disease, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing, 100034 China ,grid.411472.50000 0004 1764 1621Echocardiography Core Lab, Institute of Cardiovascular Disease at Peking University First Hospital, Beijing, China
| | - Chonghui Wang
- grid.411472.50000 0004 1764 1621Division of Cardiology, Department of Cardiovascular Disease, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing, 100034 China
| | - Yan Zhang
- grid.411472.50000 0004 1764 1621Division of Cardiology, Department of Cardiovascular Disease, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing, 100034 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
| | - Yong Huo
- grid.411472.50000 0004 1764 1621Division of Cardiology, Department of Cardiovascular Disease, Peking University First Hospital, Dahongluochang Street, Xicheng District, Beijing, 100034 China ,grid.419897.a0000 0004 0369 313XKey Laboratory of Molecular Cardiovascular Sciences (Peking University), Ministry of Education, Beijing, China
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Nakayama T, Oshima Y, Shintani Y, Yamamoto J, Yokoi M, Ito T, Wakami K, Kitada S, Goto T, Hashimoto H, Kusumoto S, Sugiura T, Iida S, Seo Y. Ventricular Sigmoid Septum as a Risk Factor for Anthracycline-Induced Cancer Therapeutics-Related Cardiac Dysfunction in Patients With Malignant Lymphoma. Circ Rep 2022; 4:173-182. [PMID: 35434414 PMCID: PMC8977195 DOI: 10.1253/circrep.cr-21-0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/26/2022] [Accepted: 03/06/2022] [Indexed: 11/28/2022] Open
Abstract
Background: Identifying risk factors for cancer therapeutics-related cardiac dysfunction (CTRCD) is essential for the early detection and prompt initiation of medial therapy for CTRCD. No study has investigated whether the sigmoid septum is a risk factor for anthracycline-induced CTRCD. Methods and Results: We enrolled 167 patients with malignant lymphoma who received a CHOP-like regimen from January 2008 to December 2017 and underwent both baseline and follow-up echocardiography. Patients with left ventricular ejection fraction (LVEF) ≤50% were excluded. CTRCD was defined as a ≥10% decline in LVEF and LVEF <50% after chemotherapy. The angle between the anterior wall of the aorta and the ventricular septal surface (ASA) was measured to quantify the sigmoid septum. CTRCD was observed in 36 patients (22%). Mean LVEF and global longitudinal strain (GLS) were lower, left ventricular mass index was higher, and ASA was smaller in patients with CTRCD. In a multivariable Cox proportional hazard analysis, GLS (hazard ratio [HR] per 1% decrease 1.20; 95% confidence interval [CI] 1.07–1.35) and ASA (HR per 1° increase 0.97; 95% CI 0.95–0.99) were identified as independent determinants of CTRCD. An integrated discrimination improvement evaluation confirmed the significant incremental value of ASA for developing CTRCD. Conclusions: Smaller ASA was an independent risk factor and had significant incremental value for CTRCD in patients with malignant lymphoma who received the CHOP-like regimen.
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Affiliation(s)
- Takafumi Nakayama
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Yoshiko Oshima
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences
| | - Yasuhiro Shintani
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Junki Yamamoto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masashi Yokoi
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Tsuyoshi Ito
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Kazuaki Wakami
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shuichi Kitada
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Toshihiko Goto
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Hiroya Hashimoto
- Clinical Research Management Center, Nagoya City University Hospital
| | - Shigeru Kusumoto
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences
| | - Tomonori Sugiura
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Shinsuke Iida
- Department of Hematology and Oncology, Nagoya City University Graduate School of Medical Sciences
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
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Balaban Y, Varım P. Relationship of Aortoseptal Angle with Chronic Hypertension, Clinical and Laboratory Data. Int Heart J 2022; 63:1099-1106. [DOI: 10.1536/ihj.21-471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Perihan Varım
- Department of Cardiology, Sakarya University Faulty of Medicine
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Li Z, Yu S, Han X, Liu J, Yao H. Changes to cardiovascular risk factors over 7 years: a prospective cohort study of in situ urbanised residents in the Chaoyang District of Beijing. BMJ Open 2020; 10:e033548. [PMID: 32184308 PMCID: PMC7076243 DOI: 10.1136/bmjopen-2019-033548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES To examine changes in cardiovascular risk factors of in situ urbanised residents between 2010 and 2017. DESIGN Population-based cohort study. SETTING The Chaoyang District of Beijing, China. PARTICIPANTS A total of 942 in situ urbanised rural residents aged 35-64 who participated in the cardiovascular disease (CVD) risk factors study in China between 2010 and 2017. MAIN OUTCOME MEASURES Lifestyles (smoking, drinking and effective exercise) and medical history (diabetes, hypertension, dyslipidaemia, overweight and obesity) were self-reported. New cases of diabetes, hypertension, dyslipidaemia, overweight and obesity were confirmed by physical examination or blood biochemical tests. Multiple linear regression and log-binomial models analyses adjusted for sociodemographic confounders were conducted to evaluate any changes of clinical indexes and to estimate prevalence rate ratios (PRRs), respectively. RESULTS During the study period of 2010-2017, diastolic blood pressure elevated by 3.55 mm Hg, central blood pressure increased by 4.39 mm Hg, total cholesterol decreased by 0.29 mmol/L and hypertension increased significantly (PRR=1.25, p<0.05) after adjusting for demographic, lifestyle and family history factors. Effective exercise rate (PRR=1.57), prevalence of diabetes (PRR=1.36) and dyslipidaemia (PRR=1.19) all increased from 2010 to 2017. However, these changes were not significant after adjusting for confounders (p>0.05). Prevalence of smoking, drinking, hypertension, overweight and obesity was significantly higher in males than females in both 2010 and 2017. In 2017, the 10-year risk of atherosclerotic CVD increased in 29.8% of participants and decreased in 6.1% of individuals. CONCLUSIONS CVD risk factors augmented remarkably for in situ urbanised rural residents aged 35-64 in the Chaoyang District of Beijing, especially those indicators related to blood pressure. Awareness of the direction and magnitude of these risk factor changes may be beneficial in informing targeted strategies for preventing CVDs of in situ urbanised populations.
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Affiliation(s)
- Zhe Li
- Office for Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
- Department for Chronic and Noncommunicable Disease Control and Prevention, Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Shicheng Yu
- Office for Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoyan Han
- Department for Chronic and Noncommunicable Disease Control and Prevention, Chaoyang District Center for Disease Control and Prevention, Beijing, China
| | - Jianjun Liu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Hongyan Yao
- Office for Epidemiology, Chinese Center for Disease Control and Prevention, Beijing, China
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Nichols WW, Denardo SJ, Johnson BD, Sharaf BL, Bairey Merz CN, Pepine CJ. Increased wave reflection and ejection duration in women with chest pain and nonobstructive coronary artery disease: ancillary study from the Women's Ischemia Syndrome Evaluation. J Hypertens 2013; 31:1447-54; discussion 1454-5. [PMID: 23615325 PMCID: PMC3766396 DOI: 10.1097/hjh.0b013e3283611bac] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Wave reflections augment central aortic SBP and increase systolic pressure time integral (SPTI) thereby increasing left ventricular (LV) afterload and myocardial oxygen (MVO2) demand. When increased, such changes may contribute to myocardial ischemia and angina pectoris, especially when aortic diastolic time is decreased and myocardial perfusion pressure jeopardized. Accordingly, we examined pulse wave reflection characteristics and diastolic timing in a subgroup of women with chest pain (Women's Ischemia Syndrome Evaluation, WISE) and no obstructive coronary artery disease (CAD). METHODS Radial artery BP waveforms were recorded by applanation tonometry, and aortic BP waveforms derived. Data from WISE participants were compared with data from asymptomatic women (reference group) without chest pain matched for age, height, BMI, mean arterial BP, and heart rate. RESULTS Compared with the reference group, WISE participants had higher aortic SBP and pulse BP and ejection duration. These differences were associated with increased augmentation index and reflected pressure wave systolic duration. These modifications in wave reflection characteristics were associated with increased SPTI and wasted LV energy (Ew) and a decrease in pulse pressure amplification, myocardial viability ratio, and diastolic pressure time fraction. CONCLUSION WISE participants with no obstructive CAD have changes in systolic wave reflections and diastolic timing that increase LV afterload, MVO2 demand, and Ew with the potential to reduce coronary artery perfusion. These alterations in cardiovascular function contribute to an undesirable mismatch in the MVO2 supply/demand that promotes ischemia and chest pain and may contribute to, or increase the severity of, future adverse cardiovascular events.
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Affiliation(s)
- Wilmer W Nichols
- Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville, Florida 32601, USA
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