Aortic calcification is associated with arterial stiffening, left ventricular hypertrophy, and diastolic dysfunction in elderly male patients with hypertension

Background: Stiffening of large arteries can result in changes of cardiac structure and function by increasing afterload to the left ventricle. Calcification has been proposed as a mechanism underlying progression of arterial stiffening. The aim of the current study was to investigate the relationship between aortic calcification, arterial stiffening, left ventricular hypertrophy, and diastolic dysfunction. Methods: One hundred and sixty-four hypertensive elderly (≥65 years old) male patients with normal left ventricular systolic function (left ventricular ejection fraction ≥55%) underwent transthoracic echocardiography, brachial-ankle pulse wave velocity (baPWV), and noncontrast computed tomography. Coronary artery calcium score and aorta calcium score (ACS) were measured on noncontrast computed tomography using the volume method. Left ventricular dimensions, mitral inflow velocities, and early mitral annular (E′) velocity were measured using transthoracic echocardiography. The left ventricular mass index (LVMI) was calculated. Results: The log ACS was associated with mean baPWV (r=0.387, P=0.001), LVMI (r=0.241, P<0.002), E′ velocity (r=-0.293, P<0.001), and E/E′ (r=0.194, P=0.013), suggesting arterial stiffening, increased left ventricular mass, and diastolic dysfunction in patients with raised ACS. On multivariate analysis, the LVMI showed an independent positive association with the log ACS, even after adjusting for various clinical variables and the coronary artery calcium score (P=0.009). Similarly, E′ velocity also demonstrated an independent negative association with the log ACS on multivariate analysis (P=0.003). The mean baPWV, LVMI, and E′ velocity showed similar correlations with both thoracic and abdominal ACS, even when thoracic and abdominal calcium scores were calculated separately. Conclusion: Heavy aortic calcification and resultant arterial stiffening might underlie left ventricular hypertrophy and diastolic dysfunction in elderly male patients with hypertension.