PWV to GLS Ratio in the General Population: Reference Values, Correlates, and Predictive Value of a Noninvasive Ventricular-Arterial Index

Abstract

Purpose

Noninvasive imaging markers combining ventricular and arterial properties may help predict cardiac disease. We conducted a general population study to determine reference values, clinical correlates, and the predictive value of the ratio of the carotid-femoral pulse wave velocity (cfPWV) to the left ventricular global longitudinal strain (GLS).

Methods

We measured cfPWV by applanation tonometry and 4-chamber GLS by echocardiography in 1026 individuals (mean age 50.3 years; 52% women). We derived reference values for cfPWV/GLS from a low-risk subsample. Clinical correlates of cfPWV/GLS were determined by stepwise regression. We calculated multivariable-adjusted hazard ratios (HR) for incident cardiovascular (CV) events (median follow-up: 10.1 years).

Results

Upper limits of normality for cfPWV/GLS varied with sex and age, ranging from 0.41 m/s% in young women up to 0.64 m/s% in older men. Higher cfPWV/GLS correlated directly with male sex, age, heart rate, pulse pressure, mean arterial pressure, and left ventricular mass (p < 0.05 for all). On a continuous scale, only GLS was a significant predictor of CV events after adjustment (HR per 1% decrease: 1.11; p = 0.0078). A cfPWV/GLS ratio above the median (>0.37 m/s%) did predict future CV events after adjustment (HR vs. below median: 2.02; p = 0.0067). However, abnormal cfPWV/GLS defined by reference limits or by cutoffs from literature did not independently predict CV events (p ≥ 0.31 for all).

Conclusion

Age- and sex-specific reference values for cfPWV/GLS were reported. cfPWV/GLS related to age, sex, and blood pressure. In contrast to GLS, cfPWV/GLS did not emerge as an independent predictor for CV events in the community.