Introduction: In asymptomatic men, arterial stiffness and wave reflections have been linked with cardiorespiratory fitness. We previously reported a relationship between arterial properties and objective measures of systolic and diastolic function in patients with preserved ejection fraction (EF). In this study, we investigated the association between symptomatic status and arterial elastic properties in the same patient group.

Methods: In 336 patients undergoing coronary angiography, we assessed pulse wave velocity (PWV) invasively, and arterial wave reflections (Augmentation Index – AIx) non-invasively using radial applanation tonometry and a validated transfer function (SphygmoCor system). Functional status, mainly exertional dyspnea, was judged by one single investigator.

Results: Patients suffering from exertional dyspnea more often were women, and they had higher blood levels of brain natriuretic peptides and higher left ventricular enddiastolic pressures, as compared to asymptomatic controls. Brachial as well as aortic blood pressures did not differ significantly between the groups. In symptomatic patients, we observed increased PWV (9.4 +/− 2.3 m/sec vs 8.7 +/− 2.6 m/sec in asymptomatic patients, p=0.01), and increased AIx (31.1 +/− 9.7 vs 28.0 +/− 10.8 in asymptomatic patients, p=0.008). In a logistic regression model, female gender, use of nitrates, and higher PWV were independently associated with functional impairment, whereas higher AIx and higher body mass index were of borderline significance.

Conclusion: Exertional dyspnea is associated with increased arterial stiffness and increased/premature arterial wave reflections in patients with normal EF.