Association of aortic arch pulse wave velocity with left ventricular mass and lacunar brain infarcts in hypertensive patients: assessment with MR imaging

Anne Brandts, Saskia G C van Elderen, Jos J M Westenberg, Jeroen van der Grond, Mark A van Buchem, Menno V Huisman, Lucia J M Kroft, Jouke T Tamsma, Albert de Roos
Radiology 2009, 253 (3): 681-8

PURPOSE: To assess the possible association between aortic arch stiffness, which may cause hypertensive cardiovascular disease, and cardiac and cerebral end-organ damage in patients with hypertension by using magnetic resonance (MR) imaging.

MATERIALS AND METHODS: Approval from the local institutional review board was obtained, and patients gave informed consent. Fifty patients with hypertension (31 women and 19 men; mean age +/- standard deviation, 49.2 years +/- 12.7; mean systolic blood pressure, 152.1 mm Hg +/- 22.3; mean diastolic blood pressure, 88.0 mm Hg +/- 13.1), compliant for treatment with antihypertensive medication, were prospectively enrolled for MR examinations of the aorta, heart, and brain with standard pulse sequences. Aortic arch pulse wave velocity (PWV), left ventricular (LV) mass, LV systolic and diastolic function, lacunar brain infarcts, and periventricular and deep white matter hyperintensities (WMHs) were assessed. Univariable and multiple linear and logistic regression analyses were used for statistical analyses.

RESULTS: Mean aortic arch PWV was 7.3 m/sec +/- 2.5. Aortic arch PWV was statistically significantly associated with LV mass (r = 0.30, P = .03, beta = 1.73); indexes of systolic function, including ejection fraction (r = -0.38, P = .01, beta = -1.12); indexes of diastolic function, including the ratio of early diastolic to atrial contraction peak filling rates (r = -0.44, P < .01, beta = -0.11); lacunar brain infarcts (odds ratio [OR] = 1.8, P < .01); and periventricular (OR = 1.5, P = .01) and deep (OR = 1.6, P = .01) WMHs. Aortic arch PWV was statistically significantly associated with LV mass (r = 0.37, P = .03, beta = 2.11) and lacunar brain infarcts (OR = 1.8, P = .04), independent of age, sex, and hypertension duration, but not with indexes of diastolic and systolic function and WMHs.

CONCLUSION: Aortic arch stiffness is associated with LV mass and lacunar brain infarcts in hypertensive patients, independent of age, sex, and hypertension duration; these manifestations of end-organ damage may help to risk stratify hypertensive patients.

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