Pulsatile Load Components, Resistive Load and Incident Heart Failure

The Multi-Ethnic Study of Atherosclerosis (MESA)

Payman Zamani, Scott M. Lilly, Patrick Segers, David R. Jacobs, David A. Bluemke, Daniel A. Duprez, Julio A. Chirinos

Research output: Contribution to journalArticle

Abstract

Background: Left ventricular (LV) afterload is composed of systemic vascular resistance (SVR) and components of pulsatile load, including total arterial compliance (TAC), and reflection magnitude (RM). RM, which affects the LV systolic loading sequence, has been shown to strongly predict HF. Effective arterial elastance (Ea) is a commonly used parameter initially proposed to be a lumped index of resistive and pulsatile afterload. We sought to assess how various LV afterload parameters predict heart failure (HF) risk and whether RM predicts HF independently from subclinical atherosclerosis. Methods: We studied 4345 MESA participants who underwent radial arterial tonometry and cardiac output (CO) measurements with the use of cardiac MRI. RM was computed as the ratio of the backward (Pb) to forward (Pf) waves. TAC was approximated as the ratio of stroke volume (SV) to central pulse pressure. SVR was computed as mean pressure/CO. Ea was computed as central end-systolic pressure/SV. Results: During 10.3 years of follow-up, 91 definite HF events occurred. SVR (P = .74), TAC (P = .81), and Ea (P = .81) were not predictive of HF risk. RM was associated with increased HF risk, even after adjustment for other parameters of arterial load, various confounders, and markers of subclinical atherosclerosis (standardized hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.88; P = .001). Pb was also associated with an increased risk of HF after adjustment for Pf (standardized HR 1.43, 95% CI 1.17-1.75; P = .001). Conclusions: RM is an important independent predictor of HF risk, whereas TAC, SVR, and Ea are not. Our findings support the importance of the systolic LV loading sequence on HF risk, independently from subclinical atherosclerosis.

Original languageEnglish (US)
JournalJournal of Cardiac Failure
DOIs
StateAccepted/In press - Oct 7 2015

Fingerprint

Atherosclerosis
Heart Failure
Vascular Resistance
Compliance
Cardiac Output
Stroke Volume
Confidence Intervals
Blood Pressure
Manometry
Pressure

Keywords

  • Compliance
  • Heart failure
  • Vascular resistance
  • Wave reflections

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Zamani, P., Lilly, S. M., Segers, P., Jacobs, D. R., Bluemke, D. A., Duprez, D. A., & Chirinos, J. A. (Accepted/In press). Pulsatile Load Components, Resistive Load and Incident Heart Failure: The Multi-Ethnic Study of Atherosclerosis (MESA). Journal of Cardiac Failure. https://doi.org/10.1016/j.cardfail.2016.04.011

Pulsatile Load Components, Resistive Load and Incident Heart Failure : The Multi-Ethnic Study of Atherosclerosis (MESA). / Zamani, Payman; Lilly, Scott M.; Segers, Patrick; Jacobs, David R.; Bluemke, David A.; Duprez, Daniel A.; Chirinos, Julio A.

In: Journal of Cardiac Failure, 07.10.2015.

Research output: Contribution to journalArticle

Zamani, Payman ; Lilly, Scott M. ; Segers, Patrick ; Jacobs, David R. ; Bluemke, David A. ; Duprez, Daniel A. ; Chirinos, Julio A. / Pulsatile Load Components, Resistive Load and Incident Heart Failure : The Multi-Ethnic Study of Atherosclerosis (MESA). In: Journal of Cardiac Failure. 2015.
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T2 - The Multi-Ethnic Study of Atherosclerosis (MESA)

AU - Zamani, Payman

AU - Lilly, Scott M.

AU - Segers, Patrick

AU - Jacobs, David R.

AU - Bluemke, David A.

AU - Duprez, Daniel A.

AU - Chirinos, Julio A.

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N2 - Background: Left ventricular (LV) afterload is composed of systemic vascular resistance (SVR) and components of pulsatile load, including total arterial compliance (TAC), and reflection magnitude (RM). RM, which affects the LV systolic loading sequence, has been shown to strongly predict HF. Effective arterial elastance (Ea) is a commonly used parameter initially proposed to be a lumped index of resistive and pulsatile afterload. We sought to assess how various LV afterload parameters predict heart failure (HF) risk and whether RM predicts HF independently from subclinical atherosclerosis. Methods: We studied 4345 MESA participants who underwent radial arterial tonometry and cardiac output (CO) measurements with the use of cardiac MRI. RM was computed as the ratio of the backward (Pb) to forward (Pf) waves. TAC was approximated as the ratio of stroke volume (SV) to central pulse pressure. SVR was computed as mean pressure/CO. Ea was computed as central end-systolic pressure/SV. Results: During 10.3 years of follow-up, 91 definite HF events occurred. SVR (P = .74), TAC (P = .81), and Ea (P = .81) were not predictive of HF risk. RM was associated with increased HF risk, even after adjustment for other parameters of arterial load, various confounders, and markers of subclinical atherosclerosis (standardized hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.88; P = .001). Pb was also associated with an increased risk of HF after adjustment for Pf (standardized HR 1.43, 95% CI 1.17-1.75; P = .001). Conclusions: RM is an important independent predictor of HF risk, whereas TAC, SVR, and Ea are not. Our findings support the importance of the systolic LV loading sequence on HF risk, independently from subclinical atherosclerosis.

AB - Background: Left ventricular (LV) afterload is composed of systemic vascular resistance (SVR) and components of pulsatile load, including total arterial compliance (TAC), and reflection magnitude (RM). RM, which affects the LV systolic loading sequence, has been shown to strongly predict HF. Effective arterial elastance (Ea) is a commonly used parameter initially proposed to be a lumped index of resistive and pulsatile afterload. We sought to assess how various LV afterload parameters predict heart failure (HF) risk and whether RM predicts HF independently from subclinical atherosclerosis. Methods: We studied 4345 MESA participants who underwent radial arterial tonometry and cardiac output (CO) measurements with the use of cardiac MRI. RM was computed as the ratio of the backward (Pb) to forward (Pf) waves. TAC was approximated as the ratio of stroke volume (SV) to central pulse pressure. SVR was computed as mean pressure/CO. Ea was computed as central end-systolic pressure/SV. Results: During 10.3 years of follow-up, 91 definite HF events occurred. SVR (P = .74), TAC (P = .81), and Ea (P = .81) were not predictive of HF risk. RM was associated with increased HF risk, even after adjustment for other parameters of arterial load, various confounders, and markers of subclinical atherosclerosis (standardized hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.18-1.88; P = .001). Pb was also associated with an increased risk of HF after adjustment for Pf (standardized HR 1.43, 95% CI 1.17-1.75; P = .001). Conclusions: RM is an important independent predictor of HF risk, whereas TAC, SVR, and Ea are not. Our findings support the importance of the systolic LV loading sequence on HF risk, independently from subclinical atherosclerosis.

KW - Compliance

KW - Heart failure

KW - Vascular resistance

KW - Wave reflections

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