Studies investigating the relationship between heart rate (HR) and arterial stiffness or wave reflections have commonly induced HR changes through in situ cardiac pacing. Although pacing produces consistent HR changes, hemodynamics can be different with different pacing modalities. Whether the differences impact on the HR relationship with arterial stiffness or wave reflections is unknown. In the present study, 48 subjects (mean age 78±10 (SD), 9 female) with in situ cardiac pacemakers were paced at 60, 70, 80, 90 and 100 bpm under atrial, atrioventricular or ventricular pacing. At each paced heart rate, brachial cuff-based pulse wave analysis was used to determine central haemodynamic parameters, including ejection duration (ED) and augmentation index (AIx). Wave separation analysis was used to determine wave reflection magnitude (RM) and reflection index (RI). Arterial stiffness was assessed by carotid-femoral pulse wave velocity (cfPWV). Pacing modality was found to have significant effects on the HR relationship with ED (P=0.01), central aortic pulse pressure (P=0.01), augmentation pressure (P<0.0001), and magnitudes of both forward and reflected waves (P=0.05 and P=0.003, respectively), but not cfPWV (P=0.57) or AIx (P=0.38). However, at a fixed HR, significant differences in pulse pressure amplification (P<0.001), AIx (P<0.0001), RM (P=0.03) and RI (P=0.03) were observed with different pacing modalities. These results demonstrate that, whilst the HR relationships with arterial stiffness and systolic loading, as measured by cfPWV and AIx, were unaffected by pacing modality, it should still be taken into account for studies where mixed pacing modalities are present, in particular for wave reflection studies.
- arterial stiffness
- pulse wave velocity
- wave reflection
- heart rate
- Copyright © 2016, Journal of Applied Physiology