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The change in arterial stiffness over the cardiac cycle rather than diastolic stiffness is independently associated with left ventricular mass index in healthy middle-aged individuals

Hermeling, Eveliena; Vermeersch, Sebastian J.b,c; Rietzschel, Ernst R.d; de Buyzere, Marc L.d; Gillebert, Thierry C.d; van de Laar, Roel J.e; Ferreira, Isabelf; Hoeks, Arnold P.a; van Bortel, Luc M.b; Reneman, Robert S.g; Segers, Patrickb; Reesink, Koen D.a

doi: 10.1097/HJH.0b013e32834e4b75

Background: The current standard for arterial stiffness assessment, aortic pulse wave velocity (aPWV), is measured at diastolic pressure. Arterial stiffness, however, is pressure dependent. At the carotid artery level, the degree of this dependency can be quantified as the difference (ΔPWV) between systolic and diastolic (cPWVd) carotid pulse wave velocity. Biomechanically, a greater ΔPWV implies greater increases in left ventricular afterload with physical activity. Therefore, we hypothesized, that ΔPWV is more strongly associated with left ventricular mass index (LVMI) than aPWV and cPWVd.

Methods: In 1776 healthy individuals from the Asklepios cohort (age 35–55 years), ΔPWV was obtained from combined carotid artery ultrasound and tonometry recordings. Multiple linear regression analysis was performed to investigate the associations of ΔPWV, cPWVd and aPWV with LVMI, adjusting for age, sex, mean blood pressure (MBP), central pulse pressure, and other possible confounders.

Results: ΔPWV was 2.4 ± 1.2 m/s (mean ± SD), ranging from 0.8 m/s, indicating almost constant arterial stiffness over the cardiac cycle, to 4.4 m/s, reflecting substantial pressure dependency. ΔPWV was significantly associated with LVMI (β of 2.46 g/m1.7 per m/s, P < 0.001), even after full adjustment (β of 0.56 g/m1.7 per m/s, P = 0.03). cPWVd and aPWV had clear crude associations with LVMI (P < 0.001), but lost significance after adjustment (β of −0.48 and −0.33 g/m1.7 per m/s, with P = 0.11 and 0.2, respectively).

Conclusion: The change in arterial stiffness over the cardiac cycle, rather than diastolic stiffness, is independently associated with LVMI in healthy middle-aged individuals. Therefore, the pressure dependency of arterial stiffness should be considered in cardiovascular risk assessment.

aDepartment of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands

bIBiTech-bioMMeda, Ghent University

cDepartment of Clinical Pharmacology, Ghent University Hospital

dDepartment of Cardiology, Ghent University Hospital, Ghent, Belgium

eDepartment of Internal Medicine

fDepartment of Clinical Epidemiology and Medical Technology Assessment

gDepartment of Physiology, CARIM School for Cardiovascular Diseases, Maastricht University Medical Centre, Maastricht, The Netherlands

Correspondence to Koen D. Reesink, PhD, Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University Medical Centre, P.O. Box 616, 6200 MD Maastricht, The Netherlands. Tel: +31 43 388 1668; e-mail:

Abbreviations: ΔPWV, systolic–diastolic difference in carotid pulse wave velocity; A, carotid artery cross-sectional area; aPWV, aortic pulse wave velocity; cPWV, carotid pulse wave velocity; cPWVd, diastolic carotid pulse wave velocity; cPWVs, systolic carotid pulse wave velocity; D, diameter; LV, left ventricle; LVMI, left ventricular mass index; MBP, mean blood pressure; p, carotid artery pressure; PP/cPP, pulse pressure/central pulse pressure

Received 30 June, 2011

Revised 22 September, 2011

Accepted 18 October, 2011

© 2012 Lippincott Williams & Wilkins, Inc.