Left ventricular responses to acute changes in late systolic pressure augmentation in older adults

Nancy K Sweitzer, Scott J. Hetzel, Joseph Skalski, Mauricio Velez, Kevin Eggleston, Gary F. Mitchell

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background Changes in the cardiovascular system with age may predispose older persons to development of heart failure with preserved ejection fraction. Vascular stiffening, aortic pressure augmentation, and ventricular-vascular coupling have been implicated. We explored the potential for acute reductions in late systolic pressure augmentation to impact left ventricular relaxation in older persons without heart failure. Methods Sixteen older persons free of known cardiovascular disease with the exception of hypertension had noninvasive tonometry and cardiac ultrasound to evaluate central augmentation index (AI) and diastolic function at baseline and after randomized, blinded administration of intravenous B-type natriuretic peptide (BNP) and hydralazine in a crossover design. Results AI was significantly reduced after BNP (11.4±8.9 to-0.2±14.7%; P = 0.02) and nonsignificantly reduced after hydralazine (14.7±8.4% to 11.5±8.8%; P = 0.39). With decreased AI during BNP, a trend toward worsened myocardial relaxation by tissue Doppler imaging occurred (E' velocity pre-and post-BNP: 10.0±2.5 and 8.8±2.0cm/s, respectively; P = 0.06). There was a significant fall in stroke volume with BNP (68.5±18.3 to 60.9±18.1ml; P = 0.02), suggesting that changes in preload overwhelmed effects of afterload reduction on ventricular performance. With hydralazine, neither relaxation nor stroke volume changed. Conclusions Acute changes in late systolic aortic pressure augmentation do not necessarily lead to improved systolic or diastolic function in older people. Preload may be a more important determinant of cardiac performance than afterload in older people with compensated ventricular function. The potential for changes in preload to impair rather than enhance left ventricular systolic and diastolic function in older people warrants further study.CLINICAL TRIALS REGISTRATIONThis study is registered at clinicaltrials.gov as NCT00204984.

Original languageEnglish (US)
Pages (from-to)866-871
Number of pages6
JournalAmerican Journal of Hypertension
Volume26
Issue number7
DOIs
StatePublished - Jul 2013
Externally publishedYes

Fingerprint

Brain Natriuretic Peptide
Hydralazine
Blood Pressure
Stroke Volume
Blood Vessels
Arterial Pressure
Heart Failure
Ventricular Function
Manometry
Cardiovascular System
Intravenous Administration
Cross-Over Studies
Cardiovascular Diseases
Hypertension

Keywords

  • arterial stiffness
  • arterial wave reflection
  • blood pressure
  • cardiac performance
  • hypertension

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Left ventricular responses to acute changes in late systolic pressure augmentation in older adults. / Sweitzer, Nancy K; Hetzel, Scott J.; Skalski, Joseph; Velez, Mauricio; Eggleston, Kevin; Mitchell, Gary F.

In: American Journal of Hypertension, Vol. 26, No. 7, 07.2013, p. 866-871.

Research output: Contribution to journalArticle

Sweitzer, Nancy K ; Hetzel, Scott J. ; Skalski, Joseph ; Velez, Mauricio ; Eggleston, Kevin ; Mitchell, Gary F. / Left ventricular responses to acute changes in late systolic pressure augmentation in older adults. In: American Journal of Hypertension. 2013 ; Vol. 26, No. 7. pp. 866-871.
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abstract = "Background Changes in the cardiovascular system with age may predispose older persons to development of heart failure with preserved ejection fraction. Vascular stiffening, aortic pressure augmentation, and ventricular-vascular coupling have been implicated. We explored the potential for acute reductions in late systolic pressure augmentation to impact left ventricular relaxation in older persons without heart failure. Methods Sixteen older persons free of known cardiovascular disease with the exception of hypertension had noninvasive tonometry and cardiac ultrasound to evaluate central augmentation index (AI) and diastolic function at baseline and after randomized, blinded administration of intravenous B-type natriuretic peptide (BNP) and hydralazine in a crossover design. Results AI was significantly reduced after BNP (11.4±8.9 to-0.2±14.7{\%}; P = 0.02) and nonsignificantly reduced after hydralazine (14.7±8.4{\%} to 11.5±8.8{\%}; P = 0.39). With decreased AI during BNP, a trend toward worsened myocardial relaxation by tissue Doppler imaging occurred (E' velocity pre-and post-BNP: 10.0±2.5 and 8.8±2.0cm/s, respectively; P = 0.06). There was a significant fall in stroke volume with BNP (68.5±18.3 to 60.9±18.1ml; P = 0.02), suggesting that changes in preload overwhelmed effects of afterload reduction on ventricular performance. With hydralazine, neither relaxation nor stroke volume changed. Conclusions Acute changes in late systolic aortic pressure augmentation do not necessarily lead to improved systolic or diastolic function in older people. Preload may be a more important determinant of cardiac performance than afterload in older people with compensated ventricular function. The potential for changes in preload to impair rather than enhance left ventricular systolic and diastolic function in older people warrants further study.CLINICAL TRIALS REGISTRATIONThis study is registered at clinicaltrials.gov as NCT00204984.",
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