Carotid Plaque, Aortic Stiffness, and Left Ventricular Longitudinal Function in Adults with Preserved Ejection Fraction

Background/Objectives: Carotid plaque and aortic pulse wave velocity (PWV) capture distinct aspects of vascular disease. We examined their associations with left ventricular global longitudinal strain (GLS) in adults with ejection fraction ≥50%. Methods: This single-center retrospective cross-sectional secondary analysis used the 2018–2019 institutional cohort, comprising preserved-EF ischemic heart disease, hypertension, and reference control groups. The primary outcome was signed GLS, for which a higher (less negative) value indicates worse shortening. Multivariable linear regression simultaneously included plaque and PWV, adjusting for age, sex, systolic blood pressure, diabetes, and source group; HC3 robust confidence intervals were used. Results: Of 128 records, 127 had evaluable PWV and GLS. Mean age was 60.8 years; 51/127 (40.2%) were women, and 37/127 (29.1%) had recorded plaque. PWV correlated with GLS (Pearson r = 0.426; p < 0.001). Adjusted GLS was 0.618 percentage points less negative per 1 m/s higher PWV (95% CI 0.280–0.956; p < 0.001). Plaque presence had no clearly detectable independent association (β = −0.348, 95% CI −1.358 to 0.661; p = 0.499). Conclusions: Higher aortic PWV was associated with less favorable longitudinal function despite preserved ejection fraction. The plaque estimate was imprecise. Cross-sectional data cannot establish temporal order or causality, and the historical ICpFE label does not independently validate an HFpEF diagnosis.