Heart Failure and Aortic Stiffening in Patients with Preserved Ejection Fraction

Abstract

Objective: This study aimed to explore a possible relationship between aortic stiffness parameters and diastolic function in patients with asymptomatic or symptomatic diastolic dysfunction, and subsequently, the effect of aortic stiffness parameters on the progression from asymptomatic diastolic dysfunction to clinical diastolic heart failure. Methods: Seventy-five subjects were enrolled in the study of whom 20 had diastolic heart failure with the left ventricle ejection fraction (LVEF) >50%, 20 had asymptomatic diastolic dysfunction with LVEF>50%, 16 had hypertension with normal diastolic function, and 19 were normotensive healthy subjects. Ascending aorta recordings for measuring aortic strain and distensibility as markers of aortic stiffness were obtained from a spot nearly 3 cm above the aortic valve using 2-D echocardiography under M-mode. Doppler echocardiography and 2-D echocardiographic measurements were used to determine diastolic function. Results: While no statistically significant difference in aortic strain or distensibility values was observed between the asymptomatic group and the diastolic heart failure group; however, E/E’ values were higher in the heart failure group [12.1 (10.0-17.1) vs. 10.0 (6.2-22.5)] (p=0.014). Aortic strain and distensibility values significantly decreased as E/E’ values increased (r = −0.416; p < 0.001 and r = −0.576; p < 0.001, respectively) for pooled data from all groups. Conclusion: Although aortic stiffness parameters did not have a direct effect on the progression from asymptomatic diastolic dysfunction to diastolic heart failure, echocardiographic monitoring of these parameters may be beneficial in identifying patients who would progress to clinical heart failure from diastolic dysfunction.

Keywords

• aortic distensibility
• aortic stiffness
• diastolic dysfunction
• heart failure with preserved ejection fraction