Zusammenhang zwischen arterieller Steifigkeit und erhöhten linksventrikulären Füllungsdrücken als pathophysiologisches Korrelat einer Herzinsuffizienz mit erhaltener Pumpfunktion - Pulswellenanalyse und Pulswellengeschwindigkeit in einem kardiovaskulären Risikokollektiv

Zusammenhang zwischen arterieller Steifigkeit und erhöhten linksventrikulären Füllungsdrücken als pathophysiologisches Korrelat einer Herzinsuffizienz mit erhaltener Pumpfunktion - Pulswellenanalyse und Pulswellengeschwindigkeit in einem kardiovaskulären Risikokollektiv

Relation between arterial stiffness and increased left ventricular filling pressures as a pathophysiological correlate of heart failure with preserved ejection fraction – pulse wave analysis and pulse wave velocity in a cardiovascular risk collective

Sebastian Seeländer

Doctoral thesis

Date of Examination: 2015-09-15

Date of issue: 2015-07-31

Advisor: Edelmann, Frank PD Dr.

Referee: Edelmann, Frank PD Dr.

Referee: Meyer, Thomas Prof. Dr.

Persistent Address: http://hdl.handle.net/11858/00-1735-0000-0022-606F-D

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Abstract

English

In 50% of all heart failure illnesses, a heart failure with preserved ejection fraction (HFpEF) is present. A diastolic dysfunction with normal or preserved left ventricular function is the pathophysiological correlate of a HFpEF. Changed vessel characteristics of the heart-following arteries are discussed to be an etiological important, extracardial factor. With the assistance of tonometry it is possible to detect a possible present arterial stiffness non-invasively. Examining the relation between arterial stiffness and HFpEF was the objective of the present work, especially in a few preselected, larger collective using diagnostic procedures, which correspond to the current recommendations of medical societies. The present work shows a family doctor recruited risk collective, in which the subjects show at least one cardiovascular risk factor. On the basis of the augmentation index and the pulse wave velocity the arterial stiffness was determined. Based on the recommendations of the American Society of Echocardiography (Nagueh et al. 2009), the subjects in a group with normal versus increased left ventricular filling pressures as correlate of a hemodynamic relevant diastolic dysfunction were classified. Altogether 257 test people were included, 38% of them with increased left ventricular filling pressures. This group was significant older, the portion of the main risk factor hypertension was higher. Likewise, more subjects in this group had exertional dyspnoea and oedemata. The left ventricular ejection fraction does not differ significantly between the groups, however, the left ventricular mass-index was higher with patients with increased filling pressures. It demonstrated that the augmentation index and the pulse wave velocity were significantly higher in the group with increased filling pressure, which refers to increased arterial stiffness. Also, after adjustment for different established independent variables, using regression models, there was a significant relation between the pulse wave velocity and the echocardiographic relevant parameter for the diagnosis of HFpEF (E/e´) as well as the presence of increased left ventricular filling pressures. In summary it is to be determined that in a few preselected, larger collective using current and established methods there is a relationship between increased left ventricular filling pressures as pathophysiological correlate of HFpEF and increased arterial stiffness. Although the relationship put out in this work presents itself less clearly than in comparable studies, which can be justified inter alia by the minor preselection of the patients in the present study, the results show that arterial stiffness represents a relevant aetiological entity in relation with the presence of HFpEF. Therefore this possible relation should be examined in larger collectives and be checked critically for pathophysiological and clinical relevance.

Keywords: arterial stiffness; heart failure with preserved ejection fraction; diastolic dysfunction; left ventricular filling pressure; pulse wave velocity; pulse wave analysis; augmentation index