THE CENTRALITY OF THE HEART IN ITS RELATIONSHIP WITH THE ARTERIAL SYSTEM: WHERE IT ALL STARTS AND ENDS

DOI

10.1016/j.artres.2017.10.003How to use a DOI?

Abstract

The interaction between the heart and large arteries represent a not fully understood process, which results from the integration of pressure wave generation, flow ejection, wave travel and reflection, and geometric mismatch between structures. Left ventricular (LV) mass and geometry, two independent predictors of worse cardiac outcomes, are modelled by changes in cardiac afterload. Central pulse pressure (cPP) itself, a marker of LV afterload, is generated from heart contraction and pressure/flow propagation into the arterial system. As such, increased cPP may be viewed as both the cause and the consequence of an increased LV work.

Our research group first described an inverse, age-dependent, relationship between aortic PWV, relative wall thickness, and the velocity of LV circumferential fiber shortening. We also showed that the relationship between cPP and stroke volume is progressively lost at increasing age. Finally, we found, in a cohort of untreated hypertensives, a pressure-independent relationship between aortic characteristic impedance, LV mass and geometry. Taken together, these results suggest that changes in LV structure and function occur as part of the compensatory response of the LV to unfavourable ventricular-vascular coupling and increased aortic stiffness.

Heart rate (HR) is another relevant effect-modifier of the interconnection between cardiac and arterial function. HR is independently associated with cardiac index, PP amplification, and aortic stiffness. Pharmacological BP-lowering interventions combined with HR-lowering effect, such as beta-blockers, are ineffective in reducing LV mass. Moreover, HR changes are positively related to DBP changes. Therefore, anti-hypertensive drugs with associated HR-lowering effect only spuriously affect the ventricular-vascular coupling. More research is needed in order to find new targets of treatment able to prevent the occurrence of structural LV remodeling.

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TY  - JOUR
AU  - Giacomo Pucci
PY  - 2017
DA  - 2017/12/06
TI  - THE CENTRALITY OF THE HEART IN ITS RELATIONSHIP WITH THE ARTERIAL SYSTEM: WHERE IT ALL STARTS AND ENDS
JO  - Artery Research
SP  - 44
EP  - 44
VL  - 20
IS  - C
SN  - 1876-4401
UR  - https://doi.org/10.1016/j.artres.2017.10.003
DO  - 10.1016/j.artres.2017.10.003
ID  - Pucci2017
ER  -