Research Article: Central and peripheral pulse wave velocity and subclinical myocardial stress and damage in older adults

Date Published: February 27, 2019

Publisher: Public Library of Science

Author(s): Shuiqing Liu, Esther D. Kim, Aozhou Wu, Michelle L. Meyer, Susan Cheng, Ron C. Hoogeveen, Christie M. Ballantyne, Hirofumi Tanaka, Gerardo Heiss, Elizabeth Selvin, Kunihiro Matsushita, Tatsuo Shimosawa.


Arterial stiffness independently predicts cardiovascular disease. However, few studies have evaluated the associations of central and peripheral pulse wave velocity (PWV) with biomarkers of both myocardial stress (natriuretic peptide [NT-proBNP]) and damage (high-sensitivity cardiac troponin-T [hs-cTnT]) among persons without cardiac disease.

We examined 3,348 participants (67–90 years) without prevalent cardiac disease in the Atherosclerosis Risk in Communities (ARIC) Study (2011–13). The cross-sectional associations of PWV quartiles for central arterial segments (carotid-femoral, heart-carotid, heart-femoral) and peripheral artery (femoral-ankle) with NT-proBNP and hs-cTnT were evaluated accounting for potential confounders.

Most PWV measures demonstrated J- or U-shaped associations with the two cardiac biomarkers. The highest (Q4) vs. second lowest (Q2) quartile of central PWV measures (carotid-femoral, heart-carotid, heart-femoral PWV) were associated with higher levels of NT-proBNP independently of demographic characteristics. The associations were less evident for hs-cTnT. These associations were attenuated after adjusting for traditional cardiovascular risk factors, but the heart-carotid PWV-NT-proBNP relationship remained borderline significant (difference in log-NT-proBNP = 0.08 [-0.01, 0.17] in Q4 vs. Q2, p = 0.07). Peripheral PWV demonstrated inverse associations. Higher values of NT-proBNP were seen in the lowest vs. second lowest quartile of all PWV measures.

Central stiffness measures showed stronger associations with cardiac biomarkers (particularly NT-proBNP) than peripheral measures among older adults without cardiac disease. Our findings are consistent with the concept of ventricular-vascular coupling and suggest that central rather than peripheral arterial hemodynamics are more closely related to myocardial stress rather than damage.

Partial Text

Arterial stiffness indicates increased rigidity and decreased elasticity of the arterial wall in response to fluctuations in pulsatile pressure [1] and is considered as an important characteristic of the vascular aging processes [2]. Stiff arteries increase left ventricular (LV) end-systolic pressure and workload, and over time, this can lead to LV hypertrophy (LVH), concentric remodeling [3], and diastolic dysfunction [4]. Indeed, arterial stiffness measures like carotid-femoral pulse wave velocity (cfPWV) are shown to independently predict cardiovascular disease (CVD) [5].

Among community-dwelling older adults without cardiac disease, higher values of central PWV measures (cfPWV, hcPWV, and hfPWV) were associated with higher levels of NT-proBNP, independently of demographic characteristics. Although these associations were considerably attenuated once adjusting for traditional cardiovascular risk factors, the relationship between the highest hcPWV quartile and higher levels of NT-proBNP remained borderline significant. faPWV, which is representative of peripheral stiffness, was generally inversely associated with both cardiac biomarkers. Of interest, higher values of NT-proBNP in the lowest quartile than in the second lowest quartile were seen for most PWV measures. Overall, the associations were weaker for hs-cTnT than for NT-proBNP.




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