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Arterial properties as determinants of time-varying myocardial stress in humans

(2012) HYPERTENSION. 60(1). p.64-70
Author
Organization
Project
Asklepios study
Abstract
Myocardial and arterial load are time-varying phenomena. Despite their importance in myocardial function, the arterial properties that determine time-resolved myocardial wall stress are unknown. We aimed to assess arterial properties as determinants of time-resolved myocardial stress among 1,214 men and women enrolled in the Asklepios study. Time-resolved central pressure, flow and left ventricular (LV) geometry were measured with carotid tonometry, Doppler and speckle-tracking echocardiography, respectively, for computation of arterial load and ejection-phase time-varying myocardial wall stress. For any given end-diastolic LV geometry and cardiac output, peak myocardial stress correlated directly with systemic vascular resistance (SVR; Standardized β=1.12; P<0.0001) and aortic characteristic impedance (Std β=0.17; P<0.0001). The ejection-phase stress-time integral correlated with SVR (Std β=1.06; P<0.0001), lower total arterial compliance (Std β=-0.13; P=0.0008) and earlier return of wave reflections (Std β=-0.10; P<0.0001) but not with reflection magnitude, whereas end-systolic wall stress correlated with SVR (Std β=1.06; P<0.0001) and reflection magnitude (Std β=0.12; P<0.0001). After adjustment for age, all measured arterial properties, end-diastolic LV geometry and cardiac output, women demonstrated greater peak (534 vs. 507 kdynes/cm2; P<0.0001), end-systolic (335 vs. 320 kdynes/cm2; P<0.0001) and ejection-phase stress-time integral (157 vs. 142 kdyne•s•cm-2; P<0.0001). In conclusion, different arterial properties have selective effects on time-resolved ejection-phase myocardial wall stress, which are not apparent from single-time point measurements. Women demonstrate less efficient myocardial-arterial coupling, with higher wall stress development for any given LV geometry, arterial properties and flow output. These observations may relate to the differential susceptibility of women to heart failure.
Keywords
afterload, arterial load, wave reflections, sex differences, myocardial stress, LEFT-VENTRICULAR HYPERTROPHY, SYSTOLIC PRESSURE, WAVE REFLECTION, HEART-FAILURE, IMPEDANCE, VOLUME

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Citation

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Chicago
Chirinos Medina, Julio, Patrick Segers, Thierry Gillebert, Amit Gupta, Marc De Buyzere, Dirk De Bacquer, Martin St John-Sutton, and Ernst Rietzschel. 2012. “Arterial Properties as Determinants of Time-varying Myocardial Stress in Humans.” Hypertension 60 (1): 64–70.
APA
Chirinos Medina, J., Segers, P., Gillebert, T., Gupta, A., De Buyzere, M., De Bacquer, D., St John-Sutton, M., et al. (2012). Arterial properties as determinants of time-varying myocardial stress in humans. HYPERTENSION, 60(1), 64–70.
Vancouver
1.
Chirinos Medina J, Segers P, Gillebert T, Gupta A, De Buyzere M, De Bacquer D, et al. Arterial properties as determinants of time-varying myocardial stress in humans. HYPERTENSION. 2012;60(1):64–70.
MLA
Chirinos Medina, Julio, Patrick Segers, Thierry Gillebert, et al. “Arterial Properties as Determinants of Time-varying Myocardial Stress in Humans.” HYPERTENSION 60.1 (2012): 64–70. Print.
@article{2132838,
  abstract     = {Myocardial and arterial load are time-varying phenomena. Despite their importance in myocardial function, the arterial properties that determine time-resolved myocardial wall stress are unknown. We aimed to assess arterial properties as determinants of time-resolved myocardial stress among 1,214 men and women enrolled in the Asklepios study. Time-resolved central pressure, flow and left ventricular (LV) geometry were measured with carotid tonometry, Doppler and speckle-tracking echocardiography, respectively, for computation of arterial load and ejection-phase time-varying myocardial wall stress. For any given end-diastolic LV geometry and cardiac output, peak myocardial stress correlated directly with systemic vascular resistance (SVR; Standardized \ensuremath{\beta}=1.12; P{\textlangle}0.0001) and aortic characteristic impedance (Std \ensuremath{\beta}=0.17; P{\textlangle}0.0001). The ejection-phase stress-time integral correlated with SVR (Std \ensuremath{\beta}=1.06; P{\textlangle}0.0001), lower total arterial compliance (Std \ensuremath{\beta}=-0.13; P=0.0008) and earlier return of wave reflections (Std \ensuremath{\beta}=-0.10; P{\textlangle}0.0001) but not with reflection magnitude, whereas end-systolic wall stress correlated with SVR (Std \ensuremath{\beta}=1.06; P{\textlangle}0.0001) and reflection magnitude (Std \ensuremath{\beta}=0.12; P{\textlangle}0.0001). After adjustment for age, all measured arterial properties, end-diastolic LV geometry and cardiac output, women demonstrated greater peak (534 vs. 507 kdynes/cm2; P{\textlangle}0.0001), end-systolic (335 vs. 320 kdynes/cm2; P{\textlangle}0.0001) and ejection-phase stress-time integral (157 vs. 142 kdyne{\textbullet}s{\textbullet}cm-2; P{\textlangle}0.0001). In conclusion, different arterial properties have selective effects on time-resolved ejection-phase myocardial wall stress, which are not apparent from single-time point measurements. Women demonstrate less efficient myocardial-arterial coupling, with higher wall stress development for any given LV geometry, arterial properties and flow output. These observations may relate to the differential susceptibility of women to heart failure.},
  author       = {Chirinos Medina, Julio and Segers, Patrick and Gillebert, Thierry and Gupta, Amit and De Buyzere, Marc and De Bacquer, Dirk and St John-Sutton, Martin and Rietzschel, Ernst},
  issn         = {0194-911X},
  journal      = {HYPERTENSION},
  keyword      = {afterload,arterial load,wave reflections,sex differences,myocardial stress,LEFT-VENTRICULAR HYPERTROPHY,SYSTOLIC PRESSURE,WAVE REFLECTION,HEART-FAILURE,IMPEDANCE,VOLUME},
  language     = {eng},
  number       = {1},
  pages        = {64--70},
  title        = {Arterial properties as determinants of time-varying myocardial stress in humans},
  url          = {http://dx.doi.org/10.1161/HYPERTENSIONAHA.112.190710},
  volume       = {60},
  year         = {2012},
}

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