Background
Materials and methods
Study participants
Echocardiography
Arterial measurements
Other measurements
Statistical analysis
Results
Characteristics of participants
Characteristic | Men (n = 197) | Women (n = 159) | P value |
---|---|---|---|
Anthropometrics
| |||
Age, y | 53.2 ± 14.6 | 54.8 ± 12.5 | 0.27 |
Body mass index, kg/m2 | 27.3 ± 3.56 | 26.5 ± 4.32 | 0.060 |
Systolic BP, mm Hg | 131.6 ± 14.8 | 129.3 ± 17.3 | 0.18 |
Diastolic BP, mm Hg | 85.3 ± 9.33 | 81.4 ± 8.85 | < 0.0001 |
Pulse pressure, mm Hg | 46.3 ± 12.8 | 48.0 ± 13.8 | 0.23 |
Mean arterial pressure, mm Hg | 100.7 ± 9.72 | 97.4 ± 10.5 | 0.0020 |
Heart rate, bpm | 58.5 ± 8.98 | 60.6 ± 8.71 | 0.026 |
Questionnaire data
| |||
Current smoking, n (%) | 31 (15.7) | 31 (19.5) | 0.35 |
Drinking alcohol, n (%) | 119 (60.4) | 37 (23.3) | < 0.0001 |
Hypertensive, n (%) | 100 (50.8) | 69 (43.4) | 0.17 |
Treated for hypertension, n (%) | 54 (27.4) | 38 (23.9) | 0.45 |
β-blockers, n (%) | 25 (12.7) | 18 (11.3) | 0.69 |
ACE or ARB, n (%) | 26 (13.2) | 10 (6.3) | 0.032 |
CCB, n (%) | 18 (9.1) | 7 (4.4) | 0.082 |
Diuretics, n (%) | 18 (9.1) | 16 (10.1) | 0.77 |
History of diabetes, n (%) | 8 (4.1) | 8 (5.0) | 0.66 |
Biochemical data
| |||
Serum creatinine, μmol/L | 81.6 ± 13.0 | 66.2 ± 17.9 | < 0.0001 |
Total cholesterol, mmol/L | 4.84 ± 0.93 | 5.28 ± 0.96 | < 0.0001 |
Serum insulin, μmol/L | 5.20 (2.20–12.0) | 4.67 (2.00–10.7) | 0.10 |
Characteristic | Men (n = 197) | Women (n = 159) | P value |
---|---|---|---|
Arterial characteristics
| |||
AP, mm Hg | 10.3 ± 8.00 | 15.3 ± 9.55 | < 0.0001 |
Central PP, mm Hg | 40.3 ± 12.1 | 44.5 ± 14.3 | 0.0059 |
PWV, m/sa | 8.18 ± 1.90 | 7.94 ± 1.94 | 0.30 |
LV end-diastolic dimensions
| |||
Internal diameter, cm | 5.27 ± 0.40 | 4.85 ± 0.35 | < 0.0001 |
Septal wall thickness, cm | 1.05 ± 0.13 | 0.92 ± 0.12 | < 0.0001 |
Posterior wall thickness, cm | 0.99 ± 0.11 | 0.88 ± 0.094 | < 0.0001 |
Relative wall thickness | 0.39 ± 0.053 | 0.37 ± 0.043 | 0.0041 |
LV mass index, g/m2 | 101.9 ± 20.8 | 86.2 ± 15.4 | < 0.0001 |
Echocardiographic volumes
| |||
LA volume index, ml/m2 | 28.0 ± 8.46 | 26.1 ± 6.70 | 0.021 |
LV EDV index, ml/m2 | 55.9 ± 9.42 | 46.6. ± 8.12 | < 0.0001 |
LV ESV index, ml/m2 | 23.0 ± 4.57 | 18.3 ± 3.83 | < 0.0001 |
LV Stroke volume, ml | 66.4 ± 13.6 | 50.0 ± 11.7 | < 0.0001 |
LV Ejection fraction, % | 58.9 ± 4.99 | 60.7 ± 5.11 | 0.0010 |
LV diastolic function
| |||
E peak, cm/s | 63.1 ± 13.9 | 69.3 ± 14.9 | < 0.0001 |
A peak, cm/s | 55.3 ± 14.1 | 63.0 ± 15.4 | < 0.0001 |
E/A ratio | 1.22 ± 0.44 | 1.18 ± 0.44 | 0.33 |
e’ peak, cm/s | 9.97 ± 3.29 | 10.0 ± 3.15 | 0.94 |
a’ peak, cm/s | 9.76 ± 2.09 | 9.31 ± 1.88 | 0.036 |
E/e’ ratio | 6.76 ± 1.87 | 7.42 ± 2.32 | 0.0038 |
LV strain
| |||
Global LS | 18.5 ± 1.84 | 20.3 ± 1.87 | < 0.0001 |
Ejection work density
| |||
EWD, Pa | 635.8 ± 179.6 | 782.3 ± 224.7 | < 0.0001 |
EWD / RWT, Pa | 1665.2 ± 498.4 | 2109.1 ± 592.1 | < 0.0001 |
Anthropometric and clinical determinants of EWD
Associations of EWD with arterial hemodynamics and stiffness
Ejection work density (Pa) | |||||||
---|---|---|---|---|---|---|---|
All (n = 356) | Men (n = 197) | Women (n = 159) | |||||
Parameter estimate (95% CI) | P value | Parameter estimate (95% CI) | P value | Parameter estimate (95% CI) | P value |
P
int
| |
Conventional (brachial) BP
| |||||||
Systolic BP, + 16 mmHg | 95.2 (76.8 to 113.6) | < 0.0001 | 82.8 (58.6 to 107.0) | < 0.0001 | 102.8 (74.7 to 130.9) | < 0.0001 | 0.074 |
Diastolic BP, + 9.5 mmHg | 37.2 (17.0 to 57.4) | 0.0003 | 28.0 (3.93 to 52.1) | 0.023 | 52.3 (18.3 to 86.3) | 0.0028 | 0.096 |
Pulse pressure, + 13 mmHg | 82.1 (63.9 to 100.3) | < 0.0001 | 66.3 (43.2 to 89.4) | < 0.0001 | 94.2 (65.2 to 123.3) | < 0.0001 | 0.028 |
MAP, + 10 mmHg | 69.6 (50.8 to 88.4) | < 0.0001 | 57.4 (33.6 to 81.1) | < 0.0001 | 81.9 (52.4 to 111.5) | < 0.0001 | 0.043 |
SphygmoCor indexes
| |||||||
AP, + 9 mmHg | 59.1 (31.5 to 86.6) | < 0.0001 | 74.3 (33.2 to 115.2) | 0.0005 | 50.0 (12.3 to 87.7) | 0.0098 | 0.42 |
Central PP, + 13 mmHg | 65.7 (44.9 to 86.4) | < 0.0001 | 65.3 (37.4 to 93.2) | < 0.0001 | 62.5 (31.5 to 93.6) | 0.0001 | 0.33 |
PWV, 1.9 m/sa | 44.8 (19.5 to 70.1) | 0.0006 | 39.1 (7.87 to 70.3) | 0.015 | 44.0 (1.82 to 86.2) | 0.041 | 0.47 |
Associations between EWD and LV structure and function
Ejection work density (Pa) | |||||||
---|---|---|---|---|---|---|---|
All (n = 356) | Men (n = 197) | Women (n = 159) | |||||
LV and LA geometry
| Parameter estimate (95% CI) | P value | Parameter estimate (95% CI) | P value | Parameter estimate (95% CI) | P value |
P
int
|
LV dimensions
| |||||||
Internal diameter, + 0.43 cm | 10.7 (−14.2 to 35.6) | 0.40 | 16.7 (−11.8 to 45.2) | 0.25 | 10.0 (−34.9 to 55.0) | 0.66 | 0.87 |
Septal wall, + 0.14 cm | −7.99 (−32.8 to 16.9) | 0.53 | − 23.9 (−51.4 to 3.62) | 0.088 | 23.4 (−22.6 to 69.5) | 0.32 | 0.0063 |
Posterior wall, + 0.12 cm | −14.8 (−40.2 to 10.6) | 0.25 | −34.3 (−61.1 to −7.42) | 0.013 | 28.3 (− 22.5 to 79.1) | 0.27 | 0.0014 |
RWT, + 0.05 | −13.2 (− 34.3 to 7.85) | 0.22 | −29.9 (−53.1 to − 6.66) | 0.012 | 12.3 (− 27.0 to 51.6) | 0.54 | 0.0069 |
LV mass index, + 20 g/m2 | 6.06 (− 16.4 to 28.5) | 0.60 | −11.0 (−35.8 to 13.8) | 0.38 | 46.1 (3.39 to 88.7) | 0.035 | 0.0039 |
Volumes
| |||||||
LA volume index, + 7.8 ml/m2 | 41.2 (19.2 to 63.2) | 0.0003 | 23.9 (1.73 to 49.6) | 0.067 | 76.2 (37.7 to 114.6) | 0.0001 | 0.0019 |
EDV index, + 10 ml/m2 | 23.0 (1.18 to 44.8) | 0.039 | 12.3 (−13.1 to 37.7) | 0.34 | 43.8 (5.30 to 82.3) | 0.026 | 0.14 |
ESV index, + 5 ml/m2 | 10.3 (−12.1 to 32.7) | 0.37 | −8.09 (−33.6 to 17.4) | 0.53 | 39.8 (−0.90 to 80.5) | 0.055 | 0.031 |
Stroke volume, + 15 ml | 27.9 (3.49 to 52.4) | 0.025 | 25.6 (−1.69 to 52.8) | 0.066 | 37.8 (−8.22 to 83.9) | 0.11 | 0.73 |
Ejection fraction, + 5.1% | 11.5 (−7.26 to 30.2) | 0.23 | 23.9 (1.16 to 46.6) | 0.040 | 1.19 (−30.1 to 32.4) | 0.94 | 0.13 |
Ejection work density (Pa) | |||||||
---|---|---|---|---|---|---|---|
All (n = 356) | Men (n = 197) | Women (n = 159) | |||||
LV diastolic function index
| Parameter estimate (95% CI) | P value | Parameter estimate (95% CI) | P value | Parameter estimate (95% CI) | P value |
P
int
|
E peak, + 15 cm/s | 55.3 (33.0 to 77.5) | < 0.0001 | 38.8 (11.3 to 66.3) | 0.0059 | 86.7 (51.2 to 122.3) | < 0.0001 | 0.39 |
A peak, + 15 cm/s | 47.2 (20.6 to 73.8) | 0.0005 | 43.9 (9.50 to 78.2) | 0.013 | 45.5 (39.0 to 87.2) | 0.032 | 0.16 |
E/A ratio, + 0.45 | 29.1 (−2.30 to 60.4) | 0.069 | 17.0 (−20.9 to 54.9) | 0.38 | 58.3 (5.50 to 111.1) | 0.031 | 0.39 |
e’ peak, + 3.2 cm/s | 32.2 (−0.031 to 64.3) | 0.050 | 48.6 (10.3 to 87.0) | 0.013 | 16.5 (−36.7 to 72.7) | 0.56 | 0.014 |
a’ peak, + 2.0 cm/s | 19.7 (−4.97 to 44.4) | 0.12 | 33.9 (5.42 to 52.3) | 0.020 | −8.96 (−51.9 to 34.0) | 0.68 | 0.75 |
E/e’ ratio, + 2.1 | 32.1 (9.20 to 55.1) | 0.0062 | 2.45 (−31.1 to 36.1) | 0.89 | 51.1 (19.6 to 82.6) | 0.0017 | 0.0016 |