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Impact of aortic root size on left ventricular afterload and stroke volume

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Abstract

Purpose

The left ventricle (LV) ejects blood into the proximal aorta. Age and hypertension are associated with stiffening and dilation of the aortic root, typically viewed as indicative of adverse remodeling. Based on analytical considerations, we hypothesized that a larger aortic root should be associated with lower global afterload (effective arterial elastance, EA) and larger stroke volume (SV). Moreover, as antihypertensive drugs differ in their effect on central blood pressure, we examined the role of antihypertensive drugs for the relation between aortic root size and afterload.

Methods

We studied a large group of patients (n = 1250; 61 ± 12 years; 78 % males; 64 % hypertensives) from a single-center registry with known or suspected coronary artery disease. Aortic root size was measured by echocardiography as the diameter of the tubular portion of the ascending aorta. LV outflow tract Doppler was used to record SV.

Results

In the population as a whole, after adjusting for key covariates in separate regression models, aortic root size was an independent determinant of both SV and EA. This association was found to be heterogeneous and stronger in patients taking a calcium channel blocker (CCB; 10.6 % of entire population; aortic root size accounted for 8 % of the explained variance of EA).

Conclusion

Larger aortic root size is an independent determinant of EA and SV. This association was heterogeneous and stronger in patients on CCB therapy.

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Fig. 1
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Abbreviations

ACE:

Angiotensin-converting enzyme

AR:

Aortic regurgitation

BSA:

Body surface area

CA :

Arterial compliance

CAFÉ:

Conduit artery functional evaluation

CCB:

Calcium channel blocker

EA :

Arterial elastance

ELV :

End-systolic LV elastance

LIFE:

Losartan for endpoint reduction trial

LV:

Left ventricle

LVEDV:

Left ventricular end-diastolic volume

LVEF:

Left ventricular ejection fraction

LVESP:

Left ventricular end-systolic pressure

LVESV:

Left ventricular end-systolic volume

MAP:

Mean arterial pressure

SD:

Standard deviation

SMC:

Smooth muscle cell

SV:

Stroke volume

SVR:

Systemic vascular resistance

ZC :

Characteristic impedance

References

  • AlGhatrif M, Lakatta EG (2014) The reality of aging viewed from the arterial wall. In: Safar ME, O’Rourke MF, Frohlich ED (eds) Blood pressure and arterial wall mechanics in cardiovascular diseases. Springer-Verlag, London, p 146

    Google Scholar 

  • Altit G, Sarquella-Brugada G, Dahdah N et al (2014) Effect of dual-chamber pacemaker implantation on aortic dilatation in patients with congenital heart block. Am J Cardiol 114:1573–1577

    Article  PubMed  Google Scholar 

  • Armentano RL, Barra JG, Levenson J, Simon A, Pichel RH (1995) Arterial wall mechanics in conscious dogs. Assessment of viscous, inertial, and elastic moduli to characterize aortic wall behavior. Circ Res 76:468–478

    Article  CAS  PubMed  Google Scholar 

  • Asanoi H, Sasayama S, Kameyama T (1989) Ventriculoarterial coupling in normal and failing heart in humans. Circ Res 65:483–493

    Article  CAS  PubMed  Google Scholar 

  • Barra JG, Armentano RL, Levenson J, Fischer EI, Pichel RH, Simon A (1993) Assessment of smooth muscle contribution to descending thoracic aortic elastic mechanics in conscious dogs. Circ Res 73:1040–1050

    Article  CAS  PubMed  Google Scholar 

  • Bella JN, Wachtell K, Boman K et al (2002) Relation of left ventricular geometry and function to aortic root dilatation in patients with systemic hypertension and left ventricular hypertrophy (the LIFE study). Am J Cardiol 89:337–341

    Article  PubMed  Google Scholar 

  • Berkels R, Taubert D, Rosenkranz A, Rosen R (2003) Vascular protective effects of dihydropyridine calcium antagonists. Involvement of endothelial nitric oxide. Pharmacology 69:171–176

    Article  CAS  PubMed  Google Scholar 

  • Burkhoff D, Mirsky I, Suga H (2005) Assessment of systolic and diastolic ventricular properties via pressure-volume analysis: a guide for clinical, translational, and basic researchers. Am J Physiol Heart Circ Physiol 289:H501–H512

    Article  CAS  PubMed  Google Scholar 

  • Chemla D, Hebert JL, Coirault C et al (1998) Total arterial compliance estimated by stroke volume-to-aortic pulse pressure ratio in humans. Am J Physiol 274:H500–H505

    CAS  PubMed  Google Scholar 

  • Chevan A, Sutherland M (1991) Hierarchical partitioning. Am Stat 45:90–96

    Google Scholar 

  • Cipolli JA, Souza FA, Ferreira-Sae MC et al (2009) Sex-specific hemodynamic and non-hemodynamic determinants of aortic root size in hypertensive subjects with left ventricular hypertrophy. Hypertens Res 32:956–961

    Article  PubMed  Google Scholar 

  • Cushman WC, Materson BJ, Williams DW, Reda DJ (2001) Pulse pressure changes with six classes of antihypertensive agents in a randomized, controlled trial. Hypertension 38:953–957

    Article  CAS  PubMed  Google Scholar 

  • Davey DL, Bratton SL, Bradley DJ, Yetman AT (2011) Relation of maternal anti-Ro/La antibodies to aortic dilation in patients with congenital complete heart block. Am J Cardiol 108:561–564

    Article  PubMed  Google Scholar 

  • Desai AS, Mitchell GF, Fang JC, Creager MA (2009) Central aortic stiffness is increased in patients with heart failure and preserved ejection fraction. J Card Fail 15:658–664

    Article  PubMed  Google Scholar 

  • Dhakam Z, Yasmin McEniery CM, Burton T, Brown MJ, Wilkinson IB (2008) A comparison of atenolol and nebivolol in isolated systolic hypertension. J Hypertens 26:351–356

    Article  CAS  PubMed  Google Scholar 

  • Evangelista A, Flachskampf FA, Erbel R et al (2010) Echocardiography in aortic diseases: EAE recommendations for clinical practice. Eur J Echocardiogr 11:645–658

    Article  PubMed  Google Scholar 

  • Fouad FM, Tarazi RC, Dustan HP, Bravo EL (1978) Hemodynamics of essential hypertension in young subjects. Am Heart J 96:646–654

    Article  CAS  PubMed  Google Scholar 

  • Frank O (1899) Die Grundform des arteriellen Pulses. Erste Abhandlung, mathematische Analyse. Z Biol 37:483–526

    Google Scholar 

  • Fransen P, Van Hove CE, van Langen J et al (2012) Contribution of transient and sustained calcium influx, and sensitization to depolarization-induced contractions of the intact mouse aorta. BMC Physiol 12:9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Gardin JM, Arnold AM, Polak J, Jackson S, Smith V, Gottdiener J (2006) Usefulness of aortic root dimension in persons > or = 65 years of age in predicting heart failure, stroke, cardiovascular mortality, all-cause mortality and acute myocardial infarction (from the Cardiovascular Health Study). Am J Cardiol 97:270–275

    Article  PubMed  Google Scholar 

  • Grömping U (2006) Relative Importance for Linear Regression in R. J Stat Software 17:1–27

    Article  Google Scholar 

  • Hans CP, Koenig SN, Huang N et al (2012) Inhibition of Notch1 signaling reduces abdominal aortic aneurysm in mice by attenuating macrophage-mediated inflammation. Arterioscler Thromb Vasc Biol 32:3012–3023

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Hart JP, Cabreriza SE, Gallup CG, Hsu D, Spotnitz HM (2002) Validation of left ventricular end-diastolic volume from stroke volume and ejection fraction. ASAIO J 48:654–657

    Article  PubMed  Google Scholar 

  • Ito S, Akutsu K, Tamori Y et al (2008) Differences in atherosclerotic profiles between patients with thoracic and abdominal aortic aneurysms. Am J Cardiol 101:696–699

    Article  PubMed  Google Scholar 

  • Izzo JL Jr (2004) Arterial stiffness and the systolic hypertension syndrome. Curr Opin Cardiol 19:341–352

    Article  PubMed  Google Scholar 

  • Johnson J, Hakansson F, Shahgaldi K, Manouras A, Norman M, Sahlén A (2013) Impact of tachycardia and sympathetic stimulation by cold pressor test on cardiac diastology and arterial function in elderly females. Am J Physiol Heart Circ Physiol 304:H1002–H1009

    Article  CAS  PubMed  Google Scholar 

  • Kass DA, Kelly RP (1992) Ventriculo-arterial coupling: concepts, assumptions, and applications. Ann Biomed Eng 20:41–62

    Article  CAS  PubMed  Google Scholar 

  • Kelly RP, Ting CT, Yang TM et al (1992) Effective arterial elastance as index of arterial vascular load in humans. Circulation 86:513–521

    Article  CAS  PubMed  Google Scholar 

  • Koh KK (2000) Effects of statins on vascular wall: vasomotor function, inflammation, and plaque stability. Cardiovasc Res 47:648–657

    Article  CAS  PubMed  Google Scholar 

  • Lam CS, Xanthakis V, Sullivan LM et al (2010) Aortic root remodeling over the adult life course: longitudinal data from the Framingham Heart Study. Circulation 122:884–890

    Article  PubMed  PubMed Central  Google Scholar 

  • Lam CS, Gona P, Larson MG et al (2013) Aortic root remodeling and risk of heart failure in the Framingham Heart study. JACC Heart Fail 1:79–83

    Article  PubMed  Google Scholar 

  • Lang RM, Bierig M, Devereux RB et al (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  • Lindeman JH, Abdul-Hussien H, van Bockel JH, Wolterbeek R, Kleemann R (2009) Clinical trial of doxycycline for matrix metalloproteinase-9 inhibition in patients with an abdominal aneurysm: doxycycline selectively depletes aortic wall neutrophils and cytotoxic T cells. Circulation 119:2209–2216

    Article  CAS  PubMed  Google Scholar 

  • Mackenzie IS, McEniery CM, Dhakam Z, Brown MJ, Cockcroft JR, Wilkinson IB (2009) Comparison of the effects of antihypertensive agents on central blood pressure and arterial stiffness in isolated systolic hypertension. Hypertension 54:409–413

    Article  CAS  PubMed  Google Scholar 

  • Mancia G, Fagard R, Narkiewicz K et al (2014) 2013 ESH/ESC Practice Guidelines for the Management of Arterial Hypertension. Blood Press 23:3–16

    Article  PubMed  Google Scholar 

  • Matsui Y, Eguchi K, O’Rourke MF et al (2009) Differential effects between a calcium channel blocker and a diuretic when used in combination with angiotensin II receptor blocker on central aortic pressure in hypertensive patients. Hypertension 54:716–723

    Article  CAS  PubMed  Google Scholar 

  • Michiels CF, Van Hove CE, Martinet W, De Meyer GR, Fransen P (2014) L-type Ca2 + channel blockers inhibit the window contraction of mouse aorta segments with high affinity. Eur J Pharmacol 738:170–178

    Article  CAS  PubMed  Google Scholar 

  • Millar JA, Lever AF, Burke V (1999) Pulse pressure as a risk factor for cardiovascular events in the MRC Mild Hypertension Trial. J Hypertens 17:1065–1072

    Article  CAS  PubMed  Google Scholar 

  • Mitchell GF, Lacourciere Y, Ouellet JP et al (2003) Determinants of elevated pulse pressure in middle-aged and older subjects with uncomplicated systolic hypertension: the role of proximal aortic diameter and the aortic pressure-flow relationship. Circulation 108:1592–1598

    Article  PubMed  Google Scholar 

  • Mitchell GF, Conlin PR, Dunlap ME et al (2008) Aortic diameter, wall stiffness, and wave reflection in systolic hypertension. Hypertension 51:105–111

    Article  CAS  PubMed  Google Scholar 

  • Murgo JP, Westerhof N, Giolma JP, Altobelli SA (1981) Effects of exercise on aortic input impedance and pressure wave forms in normal humans. Circ Res 48:334–343

    Article  CAS  PubMed  Google Scholar 

  • Najjar SS, Schulman SP, Gerstenblith G et al (2004) Age and gender affect ventricular-vascular coupling during aerobic exercise. J Am Coll Cardiol 44:611–617

    Article  PubMed  Google Scholar 

  • Niederhoffer N, Marque V, Lartaud-Idjouadiene I, Duvivier C, Peslin R, Atkinson J (1997) Vasodilators, aortic elasticity, and ventricular end-systolic stress in nonanesthetized unrestrained rats. Hypertension 30:1169–1174

    Article  CAS  PubMed  Google Scholar 

  • O’Rourke M (1990) Arterial stiffness, systolic blood pressure, and logical treatment of arterial hypertension. Hypertension 15:339–347

    Article  PubMed  Google Scholar 

  • O’Rourke MF, Nichols WW (2005) Aortic diameter, aortic stiffness, and wave reflection increase with age and isolated systolic hypertension. Hypertension 45:652–658

    Article  PubMed  Google Scholar 

  • Palmieri V, Bella JN, Arnett DK et al (2001) Aortic root dilatation at sinuses of valsalva and aortic regurgitation in hypertensive and normotensive subjects: the Hypertension Genetic Epidemiology Network Study. Hypertension 37:1229–1235

    Article  CAS  PubMed  Google Scholar 

  • Pelliccia A, Di Paolo FM, De Blasiis E et al (2010) Prevalence and clinical significance of aortic root dilation in highly trained competitive athletes. Circulation 122:698–706

  • Safar ME, Bouthier JA, Levenson JA, Simon AC (1983) Peripheral large arteries and the response to antihypertensive treatment. Hypertension 5:Iii63–Iii68

  • Safar ME, Toto-Moukouo JJ, Bouthier JA et al (1987) Arterial dynamics, cardiac hypertrophy, and antihypertensive treatment. Circulation 75:I156–I1161

    Article  CAS  PubMed  Google Scholar 

  • Safar ME, Levy BI, Struijker-Boudier H (2003) Current perspectives on arterial stiffness and pulse pressure in hypertension and cardiovascular diseases. Circulation 107:2864–2869

    Article  PubMed  Google Scholar 

  • Sagawa K, Suga H, Shoukas AA, Bakalar KM (1977) End-systolic pressure/volume ratio: a new index of ventricular contractility. Am J Cardiol 40:748–753

    Article  CAS  PubMed  Google Scholar 

  • Sahlén A, Abdula G, Norman M et al (2011) Arterial vasodilatory and ventricular diastolic reserves determine the stroke volume response to exercise in elderly female hypertensive patients. Am J Physiol Heart Circ Physiol 301:H2433–H2441

    Article  PubMed  Google Scholar 

  • Sahlén A, Shahgaldi K, Aagaard P, Manouras A, Winter R, Braunschweig F (2012) Altered ventriculo-arterial coupling during exercise in athletes releasing biomarkers after endurance running. Eur J Appl Physiol 112:4069–4079

    Article  PubMed  Google Scholar 

  • Segers P, Rietzschel ER, De Buyzere ML et al (2007) Noninvasive (input) impedance, pulse wave velocity, and wave reflection in healthy middle-aged men and women. Hypertension 49:1248–1255

    Article  CAS  PubMed  Google Scholar 

  • Sunagawa K, Maughan WL, Sagawa K (1985) Optimal arterial resistance for the maximal stroke work studied in isolated canine left ventricle. Circ Res 56:586–595

    Article  CAS  PubMed  Google Scholar 

  • Van Gorp A, Van Ingen Schenau DS, Willigers J et al (1996) A technique to assess aortic distensibility and compliance in anesthetized and awake rats. Am J Physiol 270:H780–H786

    PubMed  Google Scholar 

  • Van Hove CE, Van der Donckt C, Herman AG, Bult H, Fransen P (2009) Vasodilator efficacy of nitric oxide depends on mechanisms of intracellular calcium mobilization in mouse aortic smooth muscle cells. Br J Pharmacol 158:920–930

    Article  PubMed  PubMed Central  Google Scholar 

  • Vasan RS, Larson MG, Levy D (1995) Determinants of echocardiographic aortic root size. The Framingham Heart Study. Circulation 91:734–740

    Article  CAS  PubMed  Google Scholar 

  • Vatner SF, Pagani M, Manders WT, Pasipoularides AD (1980) Alpha adrenergic vasoconstriction and nitroglycerin vasodilation of large coronary arteries in the conscious dog. J Clin Invest 65:5–14

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Virdis A, Ghiadoni L, Taddei S (2011) Effects of antihypertensive treatment on endothelial function. Curr Hypertens Rep 13:276–281

    Article  CAS  PubMed  Google Scholar 

  • Virmani R, Avolio AP, Mergner WJ et al (1991) Effect of aging on aortic morphology in populations with high and low prevalence of hypertension and atherosclerosis. Comparison between occidental and Chinese communities. Am J Pathol 139:1119–1129

    CAS  PubMed  PubMed Central  Google Scholar 

  • Wang M, Lakatta EG (2002) Altered regulation of matrix metalloproteinase-2 in aortic remodeling during aging. Hypertension 39:865–873

    Article  CAS  PubMed  Google Scholar 

  • Williams B, Lacy PS, Thom SM et al (2006) Differential impact of blood pressure-lowering drugs on central aortic pressure and clinical outcomes: principal results of the Conduit Artery Function Evaluation (CAFE) study. Circulation 113:1213–1225

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. National Heart Centre Singapore, 5 Hospital Drive, Singapore, 169609, Singapore

    Anders Sahlén, Nadira Hamid, Mohammed Rizwan Amanullah, Jiang Ming Fam, Khung Keong Yeo, Yee How Lau, Carolyn S. P. Lam & Zee Pin Ding

  2. Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, 141 86, Stockholm, Sweden

    Anders Sahlén

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  1. Anders Sahlén
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  2. Nadira Hamid
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  3. Mohammed Rizwan Amanullah
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Correspondence to Anders Sahlén.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Communicated by Keith Phillip George.

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Sahlén, A., Hamid, N., Amanullah, M.R. et al. Impact of aortic root size on left ventricular afterload and stroke volume. Eur J Appl Physiol 116, 1355–1365 (2016). https://doi.org/10.1007/s00421-016-3392-0

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  • DOI: https://doi.org/10.1007/s00421-016-3392-0

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