Associations of increased arterial stiffness with left ventricular ejection performance and right ventricular systolic pressure in mitral regurgitation before and after surgery: Wave intensity analysis.

Background: The effect of increased arterial stiffness on mitral regurgitation (MR) is not clear. Using wave intensity (WI) analysis, which is useful for analyzing ventriculo-arterial interaction, we aimed to elucidate associations of increased arterial stiffness with left ventricular (LV) ejection performance and right ventricular systolic pressure (RVSP) in MR.

Methods And Results: We noninvasively measured carotid arterial WI and stiffness parameter (β) in 98 patients with non-ischemic chronic MR before and after surgery, and 98 age-and-gender matched healthy subjects by ultrasonography. WI is defined as WI = (dP/dt)(dU/dt) [P: blood pressure, U: velocity, t: time]. The peak value of WI (W) increases with LV peak dP/dt. The temporal WI index (Q-W)st, which is the standardized interval between the Q wave of the ECG and W, is a surrogate for preejection period. Ejection fraction (EF), left atrial volume index (LAVI), effective regurgitant orifice area (ERO), RVSP, and other echocardiographic data were also obtained. W was enhanced in the MR group before surgery compared with the normal group (10.7 ± 5.7 vs 8.5 ± 3.6 × 10 mmHg m/s, p < 0.05). However, the results of two-way ANOVA showed this enhancement of W was observed only in the subgroup of MR before surgery with lower arterial stiffness (β < 13, p< 0.0001). ERO, β and LAVI were predictor variables before surgery to determine RVSP. EF and (Q-W)st before surgery were predictor variables for EF after surgery.

Conclusions: In the MR group before surgery, increased arterial stiffness suppresses compensatory enhancement of W, and increases RVSP. Prolonged (Q-W)st has the potential for predicting low EF after surgery.