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The importance of calibration method in determining the association between central blood pressure with left ventricular and left atrial strain

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Abstract

Afterload is an important determinant of left ventricular (LV) and atrial (LA) function, including myocardial strain. Central blood pressure (CBP) is the major component of cardiac afterload and independently associated with cardiovascular risk. However, the optimal means of calibrating CBP is unclear—standard CBP assessment uses systolic (SBP) and diastolic blood pressure (DBP) from brachial waveforms, but calibration with mean pressure (MAP) and DBP purports to be more accurate. Therefore, we sought to determine which CBP is best associated with LA and LV strain. CBP was measured using both standard and MAP based calibration methods in 546 participants (age 70.7 ± 4.7 years, 45% male) with risk factors for heart failure. Echocardiography was performed in all patients and strain analysis conducted to assess LA/LV function. The associations of CBP with LA and LV strain were assessed using linear regression. MAP-derived CSBP (150 ± 20 mmHg) was higher than standard CSBP (128 ± 15 mmHg) and brachial SBP (140 ± 17 mmHg, p < 0.001), whereas DBPs were similar (84 ± 10, 83 ± 10, and 82 ± 10 mmHg). MAP-derived CSBP was not independently associated with LV strain (p > 0.05), however was independently associated with LA reservoir strain (p < 0.05). Brachial and central DBP were more strongly associated with LA reservoir/conduit and LV strain than brachial and central SBP. LA pump strain was not independently associated with any SBP or DBP parameter (p > 0.05). MAP-derived CBP was more accurate in identifying patients with abnormal LA and LV strain than brachial SBP and standard CBP calibration. In conclusion, CBP calibrated using MAP and DBP may be more accurate in identifying patients with abnormal LA and LV function than standard brachial calibration methods.

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Abbreviations

ACE-I:

Angiotensin converting enzyme inhibitors

AF:

Atrial fibrillation

BMI:

Body Mass Index

BP:

Blood pressure

CBP:

Central blood pressure

DBP:

Diastolic blood pressure

ECG:

Electrocardiograph

GLS:

Global longitudinal strain

HF:

Heart failure

LA:

Left atrium

LV:

Left ventricle

LVEF:

Left ventricular ejection fraction

LVH:

Left ventricular hypertrophy

LVM:

Left ventricular mass

MAP:

Mean arterial pressure

SBP:

Systolic blood pressure

T2DM:

Type II diabetes mellitus

Tas-ELF:

Tasmanian AF screening cohort

TTE:

Transthoracic echocardiography

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Funding

S.R is supported by a research scholarship by the National Heart Foundation of Australia. This study was partially supported by Diabetes Australia, the Tasmanian Community Fund and Siemens Healthcare Australia. ECG equipment and software support were provided by Semacare Inc, a manufacturer of handheld ECG devices. The sponsors had no role in the design and conduct of the study, in the collection, analysis, and interpretation of the data, and in the preparation, review, or approval of the manuscript.

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Authors and Affiliations

  1. Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC, 3004, Australia

    Satish Ramkumar & Thomas H. Marwick

  2. School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia

    Satish Ramkumar & Thomas H. Marwick

  3. Monash Heart, Monash Cardiovascular Research Centre, Clayton, VIC, Australia

    Satish Ramkumar

  4. Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia

    Hong Yang, Mark Nolan, Tomoko Negishi, James E. Sharman, Thomas H. Marwick & Kazuaki Negishi

  5. Sydney Medical School Nepean, Charles Perkins Centre Nepean, The University of Sydney, Kingswood, NSW, Australia

    Tomoko Negishi & Kazuaki Negishi

Authors
  1. Satish Ramkumar
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  2. Hong Yang
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  3. Mark Nolan
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  4. Tomoko Negishi
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  5. James E. Sharman
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  7. Kazuaki Negishi
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Correspondence to Satish Ramkumar.

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Ramkumar, S., Yang, H., Nolan, M. et al. The importance of calibration method in determining the association between central blood pressure with left ventricular and left atrial strain. Int J Cardiovasc Imaging 38, 589–600 (2022). https://doi.org/10.1007/s10554-021-02444-4

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  • DOI: https://doi.org/10.1007/s10554-021-02444-4

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