Search

Introduction: Central arterial stiffness and wave reflections are important determinants of left ventricular afterload. Given the adverse effect of wave reflections on ventricular-vascular coupling, we sought to determine whether modern guideline-directed medical therapy (GDMT) for heart failure with reduced ejection fraction (HFrEF) influences central aortic parameters. Methods: We assessed central arterial stiffness and wave reflections in 156 subjects (mean age 55 ± 13 yrs, 46% female, 56% black) using arterial tonometry (Sphygmocor, AtCor Medical). GDMT was held for eight hours prior to acquisition of waveforms. Carotid-femoral pulse wave velocity (PWV) was measured. Pulse wave analysis of the radial artery was used to estimate central aortic pressure waveforms. ANOVA was used to compare measurements between groups based on use of GDMT. Results: Mean ejection fraction was 24 ± 9%, with 88% of subjects classified as NYHA II/III. Overall use of GDMT was high: Beta-blockers (97%), ACEi/ARB (65%), mineralocorticoid antagonists (65%), hydralazine-nitrates (19%). Measured SBP (136±31 vs. 110±17 vs. 112±18 vs. 110±18, P<0.001) and PWV (7.2±1.9 vs. 6.8±1.9 vs. 6.9±1.2 vs. 6.4±1.6 m/s, P=0.2) were numerically higher in patients on beta-blockers+ACEiARB+MCA+H-ISDN compared to patients on beta-blockers+ACEi/ARB +MCA, beta-blockers+ACEi/ARB, or beta-blocker only. Pulse wave analysis revealed higher central pressures in patients on beta-blockers+ACEi/ARB+MCA+H-ISDN compared to other groups (Figure). After adjustment for age and sex, higher SBP accounted for the difference in aortic waveforms between groups. Conclusions: HFrEF patients who tolerate more GDMT have a less favorable central aortic waveform, due to higher SBP. Central aortic waveforms could be used for targeted uptitration of GDMT. [ABSTRACT FROM AUTHOR]