The importance of calibration method in determining the association between central blood pressure with left ventricular and left atrial strain
Ramkumar, S and Yang, H and Nolan, M and Negishi, T and Marwick, TH and Negishi, K, The importance of calibration method in determining the association between central blood pressure with left ventricular and left atrial strain, International Journal of Cardiovascular Imaging ISSN 1569-5794 (2021) [Refereed Article]
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.
blood pressure, cardiac, cardiovascular, strain, left atrium, atrial function, central blood pressure