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Pastore MC, Cavigli L, Olivoni G, Morrone F, Amati F, Imbalzano E, Rinaldi A, Liga R, Mattioli AV, Scicchitano P, Curcio A, Barillà F, Ciccarelli M, Maestrini V, Perrone Filardi P, D'Ascenzi F, Cameli M. Physical exercise in hypertensive heart disease: From the differential diagnosis to the complementary role of exercise. Int J Cardiol 2024; 410:132232. [PMID: 38844090 DOI: 10.1016/j.ijcard.2024.132232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/10/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Arterial hypertension (AH) is one of the most common pathologic conditions and uncontrolled AH is a leading risk factor for cardiovascular disease and mortality. AH chronically causes myocardial and arterial remodelling with hemodynamic changes affecting the heart and other organs, with potentially irreversible consequences leading to poor outcomes. Therefore, a proper and early treatment of AH is crucial after the diagnosis. Beyond medical treatment, physical exercise also plays a therapeutic role in reducing blood pressure, given its potential effects on sympathetic tone, renin-angiotensin-aldosterone system, and endothelial function. International scientific societies recommend physical exercise among lifestyle modifications to treat AH in the first stages of the disease. Moreover, some studies have also shown its usefulness in addition to drugs to reduce blood pressure further. Therefore, an accurate, personalized exercise prescription is recommended to optimize the prevention and treatment of hypertension. On the other hand, uncontrolled AH in athletes requires proper risk stratification and careful evaluation to practice competitive sports safely. Moreover, the differential diagnosis between hypertensive heart disease and athlete's heart is sometimes challenging and requires a careful and comprehensive interpretation in order not to misinterpret the clinical findings. The present review aims to discuss the relationship between hypertensive heart disease and physical exercise, from diagnostic tools to prevention and treatment strategies.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Gabriele Olivoni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesco Morrone
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Rinaldi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Riccardo Liga
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | | | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Francesco Barillà
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Michele Ciccarelli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Italian Society of Cardiology, Federico II University of Naples, Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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de Souza Mesquita FO, Gambassi BB, de Oliveira Silva M, Moreira SR, Neves VR, Gomes-Neto M, Schwingel PA. Effect of High-Intensity Interval Training on Exercise Capacity, Blood Pressure, and Autonomic Responses in Patients With Hypertension: A Systematic Review and Meta-analysis. Sports Health 2023; 15:571-578. [PMID: 36529986 PMCID: PMC10293559 DOI: 10.1177/19417381221139343] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023] Open
Abstract
CONTEXT Despite the well-known positive effects of exercise in hypertensive patients, the best mode of exercise is still under discussion. OBJECTIVE A systematic review of the literature, synthesizing data on the effects of high-intensity interval training (HIIT) on peak oxygen consumption (VO2 peak), blood pressure (BP), cardiac autonomic modulation, and resting heart rate (HR) in patients with hypertension. DATA SOURCES MEDLINE (via PubMed), CENTRAL, PEDro database, and SciELO (from the earliest date available to December 31, 2020). STUDY SELECTION Randomized controlled trials (RCTs) that evaluated the effects of HIIT in hypertensive patients. STUDY DESIGN Systematic review and meta-analysis. LEVEL OF EVIDENCE Level 2. DATA EXTRACTION Mean differences (MDs) with a 95% CI were calculated, and heterogeneity was assessed using the I2 test. RESULTS Nine RCTs encompassing 569 patients met the eligibility criteria and were included in the systematic review. Five trials compared supervised HIIT with moderate-intensity continuous training (MICT) and a control; 1 trial compared HIIT with MICT, and 3 compared HIIT with a control. In comparison with MICT, HIIT improved VO2 peak MD (3.3 mL.kg-1.min-1; 95% CI, 1.4-5.3; N = 130). In comparison with controls, HIIT improved VO2 peak MD (4.4 mL.kg-1.min-1; 95% CI, 2.5-6.2; N = 162). CONCLUSION Despite the low quality of the evidence, HIIT is superior to MICT in improving VO2 peak in patients with hypertension. HIIT effectively improved VO2 peak, BP, and resting HR when compared with controls. HIIT appears to be safe only when performed in a supervised manner for stage 1 hypertension patients without associated risk factors.
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Affiliation(s)
- Fabricio Olinda de Souza Mesquita
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
| | - Bruno Bavaresco Gambassi
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Programa de Pós-Graduação em Gestão de Programas e Serviços de Saúde (MGPSS), São Luís, Maranhão, Brazil
| | | | - Sérgio Rodrigues Moreira
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Programa de Pós-Graduação em Ciências da Saúde e Biológicas (PPGCSB), Universidade Federal do Vale do São Francisco (UNIVASF), Petrolina, Pernambuco, Brazil
| | - Victor Ribeiro Neves
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGRDF), UPE, Petrolina, Pernambuco, Brazil
| | - Mansueto Gomes-Neto
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Departamento de Fisioterapia, Universidade Federal da Bahia (UFBA), Salvador, Bahia, Brazil
| | - Paulo Adriano Schwingel
- Programa de Pós-Graduação em Ciências da Saúde (PPGCS), Universidade de Pernambuco (UPE), Recife, Pernambuco, Brazil
- Laboratório de Pesquisas em Desempenho Humano (LAPEDH), UPE, Petrolina, Pernambuco, Brazil
- Programa de Pós-Graduação em Reabilitação e Desempenho Funcional (PPGRDF), UPE, Petrolina, Pernambuco, Brazil
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Cardiac function unchanged following reanimation with normothermic regional perfusion in donation after circulatory death. JTCVS Tech 2022; 15:136-143. [PMID: 36276687 PMCID: PMC9579788 DOI: 10.1016/j.xjtc.2022.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/19/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives To determine whether hearts reanimated with normothermic regional perfusion (NRP) have clinically detectable changes in function using echocardiography comparing the prearrest and post-NRP imaging. As heart transplantation from donation after circulatory death (DCD) continues to increase, preliminary results suggest outcomes comparable with donation after brain death. It is unknown whether the obligatory period of warm ischemia experienced during DCD withdrawal process causes immediate changes in cardiac allograft function following in situ reanimation. Methods We retrospectively reviewed and compared predonation with postreanimation echocardiographic findings in all DCD donors at our institution from January to October 2021. All DCD donor organs were reanimated with in situ thoracoabdominal NRP after circulatory death. Echocardiographic assessment included (1) 2-dimensional and speckle-tracking measures of chamber size and function; (2) ejection fraction; (3) fractional area change; and (4) global longitudinal strain. Results Altogether, 4 DCD heart donations were performed during the study period. Basic demographics and withdrawal ischemic time periods are reported. There were no changes in left ventricular ejection fraction and right ventricular fractional area change when comparing the predonation and the postreanimation echocardiogram. There was a minimal, nonstatistically significant decrease in left ventricular global longitudinal strain and right ventricular free-wall systolic strain in 3 of the 4 donors following reanimation. Conclusions DCD cardiac allografts reanimated with NRP demonstrated no change in echocardiographic parameters used for a standard predonation donor heart evaluation. Findings suggest cardiac function of DCD allografts reanimated with thoracoabdominal NRP is not adversely impacted by limited period of warm ischemia following circulatory arrest.
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Arterial Hypertension and Cardiopulmonary Function: The Value of a Combined Cardiopulmonary and Echocardiography Stress Test. High Blood Press Cardiovasc Prev 2022; 29:145-154. [PMID: 35107808 PMCID: PMC8942964 DOI: 10.1007/s40292-021-00494-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 11/23/2021] [Indexed: 11/27/2022] Open
Abstract
Arterial hypertension (AH) is a global burden and the leading risk factor for mortality worldwide. Haemodynamic abnormalities, longstanding neurohormonal and inflammatory activation, which are commonly observed in patients with AH, promote cardiac structural remodeling ultimately leading to heart failure (HF) if blood pressure values remain uncontrolled. While several epidemiological studies have confirmed the strong link between AH and HF, the pathophysiological processes underlying this transition remain largely unclear. The combined cardiopulmonary-echocardiography stress test (CPET-ESE) represents a precious non-invasive aid to detect alterations in patients at the earliest stages of HF. The opportunity to study the response of the cardiovascular system to exercise, and to differentiate central from peripheral cardiovascular maladaptations, makes the CPET-ESE an ideal technique to gain insights into the mechanisms involved in the transition from AH to HF, by recognizing alterations that might be silent at rest but influence the response to exercise. Identifications of these subclinical alterations might allow for a better risk stratification in hypertensive patients, facilitating the recognition of those at higher risk of evolution towards established HF. This may also lead to the development of novel preventive strategies and help tailor medical treatment. The purpose of this review is to summarise the potential advantages of using CPET-ESE in the characterisation of hypertensive patients in the cardiovascular continuum.
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Jordan AN, Fulford J, Gooding K, Anning C, Wilkes L, Ball C, Pamphilon N, Mawson D, Clark CE, Shore AC, Sharp ASP, Bellenger NG. Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study. J Cardiovasc Magn Reson 2021; 23:122. [PMID: 34689818 PMCID: PMC8543888 DOI: 10.1186/s12968-021-00805-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Left ventricular (LV) hypertrophy (LVH) in uncontrolled hypertension is an independent predictor of mortality, though its regression with treatment improves outcomes. Retrospective data suggest that early control of hypertension provides a prognostic advantage and this strategy is included in the 2018 European guidelines, which recommend treating grade II/III hypertension to target blood pressure (BP) within 3 months. The earliest LVH regression to date was demonstrated by echocardiography at 24 weeks. The effect of a rapid guideline-based treatment protocol on LV remodelling, with very early BP control by 18 weeks remains controversial and previously unreported. We aimed to determine whether such rapid hypertension treatment is associated with improvements in LV structure and function through paired cardiovascular magnetic resonance (CMR) scanning at baseline and 18 weeks, utilising CMR mass and feature tracking analysis. METHODS We recruited participants with never-treated grade II/III hypertension, initiating a guideline-based treatment protocol which aimed to achieve BP control within 18 weeks. CMR and feature tracking were used to assess myocardial morphology and function immediately before and after treatment. RESULTS We acquired complete pre- and 18-week post-treatment data for 41 participants. During the interval, LV mass index reduced significantly (43.5 ± 9.8 to 37.6 ± 8.3 g/m2, p < 0.001) following treatment, accompanied by reductions in LV ejection fraction (65.6 ± 6.8 to 63.4 ± 7.1%, p = 0.03), global radial strain (46.1 ± 9.7 to 39.1 ± 10.9, p < 0.001), mid-circumferential strain (- 20.8 ± 4.9 to - 19.1 ± 3.7, p = 0.02), apical circumferential strain (- 26.0 ± 5.3 to - 23.4 ± 4.2, p = 0.003) and apical rotation (9.8 ± 5.0 to 7.5 ± 4.5, p = 0.003). CONCLUSIONS LVH regresses following just 18 weeks of intensive antihypertensive treatment in subjects with newly-diagnosed grade II/III hypertension. This is accompanied by potentially advantageous functional changes within the myocardium and supports the hypothesis that rapid treatment of hypertension could improve clinical outcomes. TRIAL REGISTRATION ISRCTN registry number: 57475376 (assigned 25/06/2015).
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Affiliation(s)
- Andrew N Jordan
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK.
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK.
- Diabetes and Vascular Research Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
| | - Jon Fulford
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Kim Gooding
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Christine Anning
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Lindsay Wilkes
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Claire Ball
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Nicola Pamphilon
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - David Mawson
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Christopher E Clark
- Primary Care Research Group, Exeter College of Medicine and Health, Smeall Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Angela C Shore
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Andrew S P Sharp
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
- Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Nicholas G Bellenger
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
- Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, UK
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Mondaca-Ruff D, Araos P, Yañez CE, Novoa UF, Mora IG, Ocaranza MP, Jalil JE. Hydrochlorothiazide Reduces Cardiac Hypertrophy, Fibrosis and Rho-Kinase Activation in DOCA-Salt Induced Hypertension. J Cardiovasc Pharmacol Ther 2021; 26:724-735. [PMID: 34623176 DOI: 10.1177/10742484211053109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Thiazides are one of the most common antihypertensive drugs used for hypertension treatment and hydrochlorothiazide (HCTZ) is the most frequently used diuretic for hypertension treatment. The Rho/Rho-kinase (ROCK) path plays a key function in cardiovascular remodeling. We hypothesized that in preclinical hypertension HCTZ reduces myocardial ROCK activation and consequent myocardial remodeling. METHODS The preclinical model of deoxycorticosterone (DOCA)-salt hypertension was used (Sprague-Dawley male rats). After 3 weeks, in 3 different groups: HCTZ, the ROCK inhibitor fasudil or spironolactone was added (3 weeks). After 6 weeks myocardial hypertrophy and fibrosis, cardiac levels of profibrotic proteins, mRNA levels (RT PCR) of pro remodeling and pro oxidative molecules and ROCK activity were determined. RESULTS Blood pressure, myocardial hypertrophy and fibrosis were reduced significantly by HCTZ, fasudil and spironolactone. In the heart, increased levels of the pro-fibrotic proteins Col-I, Col-III and TGF-β1 and gene expression of pro-remodeling molecules TGF-β1, CTGF, MCP-1 and PAI-1 and the pro-oxidative molecules gp91phox and p22phox were significantly reduced by HCTZ, fasudil and spironolactone. ROCK activity in the myocardium was increased by 54% (P < 0.05) as related to the sham group and HCTZ, spironolactone and fasudil, reduced ROCK activation to control levels. CONCLUSIONS HCTZ reduced pathologic LVH by controlling blood pressure, hypertrophy and myocardial fibrosis and by decreasing myocardial ROCK activation, expression of pro remodeling, pro fibrotic and pro oxidative genes. In hypertension, the observed effects of HCTZ on the myocardium might explain preventive outcomes of thiazides in hypertension, specifically on LVH regression and incident heart failure.
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Affiliation(s)
- David Mondaca-Ruff
- Laboratory of Molecular Cardiology, Division of Cardiovascular Diseases, School of Medicine, 60709Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Patricio Araos
- Laboratory of Molecular Cardiology, Division of Cardiovascular Diseases, School of Medicine, 60709Pontificia Universidad Católica de Chile, Santiago, Chile.,Laboratorio de Fisiopatologia Renal, Instituto de Ciencias Biomédicas, 28041Universidad Autónoma de Chile, Santiago, Chile
| | - Cristián E Yañez
- Laboratory of Molecular Cardiology, Division of Cardiovascular Diseases, School of Medicine, 60709Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ulises F Novoa
- Department of Biomedical Sciences, 495640Facultad de Ciencias de la Salud, Universidad de Talca, Talca, Chile
| | - Italo G Mora
- Laboratory of Molecular Cardiology, Division of Cardiovascular Diseases, School of Medicine, 60709Pontificia Universidad Católica de Chile, Santiago, Chile
| | - María Paz Ocaranza
- Laboratory of Molecular Cardiology, Division of Cardiovascular Diseases, School of Medicine, 60709Pontificia Universidad Católica de Chile, Santiago, Chile.,Advanced Center for Chronic Diseases (ACCDiS), 60709Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for New Drugs for Hypertension (CENDHY), 60709Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jorge E Jalil
- Laboratory of Molecular Cardiology, Division of Cardiovascular Diseases, School of Medicine, 60709Pontificia Universidad Católica de Chile, Santiago, Chile.,Center for New Drugs for Hypertension (CENDHY), 60709Pontificia Universidad Católica de Chile, Santiago, Chile
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Yoshida Y, Nakanishi K, Daimon M, Ishiwata J, Sawada N, Hirokawa M, Kaneko H, Nakao T, Mizuno Y, Morita H, Di Tullio MR, Homma S, Komuro I. Sex-specific difference in the association between arterial stiffness and subclinical left ventricular dysfunction. Eur Heart J Cardiovasc Imaging 2021; 22:817-823. [PMID: 32594106 DOI: 10.1093/ehjci/jeaa156] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/22/2020] [Accepted: 05/12/2020] [Indexed: 01/01/2023] Open
Abstract
AIMS Increased arterial stiffness is one of the key mechanisms of heart failure with preserved ejection fraction (HFpEF). However, the possible association between arterial stiffness and subclinical left ventricular (LV) dysfunction and its sex-specific difference remains unclarified. LV strain is emerging as a highly sensitive tool to unmask early LV abnormalities. METHODS AND RESULTS We examined 1155 participants free of overt cardiovascular disease who underwent extensive cardiovascular examination. Speckle-tracking echocardiography was employed to assess LV global longitudinal strain (LVGLS) and circumferential strain (GCS), and arterial stiffness was assessed by cardio-ankle vascular index (CAVI). Mean age was 62 ± 12 years, and 56% were men. CAVI as continuous variable was associated with abnormal LVGLS (>-18.6%) independent of cardiovascular risk factors and echocardiographic parameters [adjusted odds ratio (OR) 1.23, P = 0.027] but not with LVGCS. In sex-stratified analysis, more pronounced association between quartiles of CAVI and abnormal LVGLS was observed in women than in men (unadjusted OR = 6.43 in women and 2.46 in men for upper quartile vs. lower quartile; both P < 0.01). CAVI was significantly associated with abnormal LVGLS independent of cardiovascular risk factors in both sexes. However, after further adjustment for LV mass index and diastolic parameters, the independent association persisted only in women (adjusted OR 1.67, P = 0.007), but not in men (adjusted OR 1.14, P = 0.227). CONCLUSION Increased arterial stiffness was independently associated with decreased LVGLS even without overt cardiovascular disease; a sex-specific pattern exists in the alteration of vascular-ventricular coupling, which might partially explain the greater susceptibility to HFpEF in women.
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Affiliation(s)
- Yuriko Yoshida
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.,Department of Clinical Laboratory, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Jumpei Ishiwata
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoko Sawada
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hidehiro Kaneko
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, 622 West 168th Street, New York, NY 10032, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, 622 West 168th Street, New York, NY 10032, USA
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Abstract
PURPOSE OF REVIEW Resistant hypertension (RH) is a major contributor to cardiovascular diseases and is associated with increased all-cause and cardiovascular mortality. Cardiac changes such as impaired left ventricular (LV) function, left ventricular hypertrophy (LVH), myocardial fibrosis, and enlarged left atrium (LA) are consequences of chronic exposure to an elevated blood pressure. The purpose of this review article is to demonstrate the potential benefits of using STE as a non-invasive imaging technique in the assessment of cardiac remodeling in patients with hypertension and specifically in uncontrolled and RH population. RECENT FINDINGS It is well-recognized that conventional transthoracic echocardiography is a useful analytic imaging modality to evaluate hypertension-mediated organ damage (HMOD) and in a resistant hypertensive population. More recently two-dimensional speckle tracking echocardiography (STE) has been utilized to provide further risk assessment to this population. Recent data has shown that STE is a new promising echocardiographic marker to evaluate early stage LV dysfunction and myocardial fibrosis over conventional 2D parameters in patients with cardiovascular diseases.
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9
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Tadic M, Cuspidi C, Pencic B, Vukomanovic V, Taddei S, Grassi G, Celic V. Association between myocardial work and functional capacity in patients with arterial hypertension: an echocardiographic study. Blood Press 2021; 30:188-195. [PMID: 33769171 DOI: 10.1080/08037051.2021.1902267] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to examine myocardial performance using pressure-strain loops in hypertensive patients with different level of blood pressure control. MATERIAL AND METHODS This cross-sectional study included 204 subjects (45 controls, 70 patients with well-controlled hypertension, 58 patients with uncontrolled hypertension and 31 patients with resistant hypertension) who underwent complete two-dimensional echocardiographic examination including two-dimensional speckle-tracking echocardiography. Pressure-strain curve was used to determine global myocardial work, constructive work, wasted work and work efficiency in all study participants. RESULTS Left ventricular (LV) longitudinal strain gradually reduced from controls throughout well-controlled hypertensive patients, to patients with uncontrolled and resistant hypertension. Global myocardial work was higher in patients with uncontrolled and resistant hypertension than in controls and well-controlled hypertension. Constructive work was also higher in all hypertensive patients than in controls. Global wasted work and work efficiency were similar between different groups. Global myocardial work index was associated with peak oxygen consumption independently of sex, age, body mass index (BMI), LV structural and functional parameters in all hypertensive participants. CONCLUSIONS Myocardial work was significantly deteriorated in patients with uncontrolled and resistant arterial hypertension compared to controls and well-controlled hypertensive patients. Global myocardial work was associated with functional capacity independent of clinical and echocardiographic parameters.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy.,Istituto Auxologico Italiano IRCCS, Clinical Research Unit, Meda, Italy
| | - Biljana Pencic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
| | - Vladan Vukomanovic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy
| | - Vera Celic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
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Nabeshima Y, Seo Y, Takeuchi M. A review of current trends in three-dimensional analysis of left ventricular myocardial strain. Cardiovasc Ultrasound 2020; 18:23. [PMID: 32591001 PMCID: PMC7320541 DOI: 10.1186/s12947-020-00204-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional (3D) left ventricular (LV) myocardial strain measurements using transthoracic 3D echocardiography speckle tracking analysis have several advantages over two-dimensional (2D) LV strain measurements, because 3D strain values are derived from the entire LV myocardium, yielding more accurate estimates of global and regional LV function. In this review article, we summarize the current status of 3D LV myocardial strain. Specifically, we describe how 3D LV strain analysis is performed. Next, we compare characteristics of 2D and 3D strain, and we explain validation of 3D strain measurements, feasibility and measurement differences between 2D and 3D strain, reference values of 3D strain, and its applications in several clinical scenarios. In some parts of this review, we used a meta-analysis to draw reliable conclusions. We also describe the added value of 3D over 2D strain in several specific pathologies and prognoses. Finally, we discuss novel techniques using 3D strain and suggest its future directions.
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Affiliation(s)
- Yosuke Nabeshima
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan.
| | - Yoshihiro Seo
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, School of Medicine, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
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11
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D’Ascenzi F, Fiorentini C, Anselmi F, Mondillo S. Left ventricular hypertrophy in athletes: How to differentiate between hypertensive heart disease and athlete’s heart. Eur J Prev Cardiol 2020; 28:1125-1133. [PMID: 33611377 DOI: 10.1177/2047487320911850] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
Abstract
Athlete’s heart is typically accompanied by a remodelling of the cardiac chambers induced by exercise. However, although competitive athletes are commonly considered healthy, they can be affected by cardiac disorders characterised by an increase in left ventricular mass and wall thickness, such as hypertension. Unfortunately, training-induced increase in left ventricular mass, wall thickness, and atrial and ventricular dilatation observed in competitive athletes may mimic the pathological remodelling of pathological hypertrophy. As a consequence, distinguishing between athlete’s heart and hypertension can sometimes be challenging. The present review aimed to focus on the differential diagnosis between hypertensive heart disease and athlete’s heart, providing clinical information useful to distinguish between physiological and pathological remodelling.
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Affiliation(s)
- Flavio D’Ascenzi
- Department of Medical Biotechnologies, University of Siena, Italy
| | | | | | - Sergio Mondillo
- Department of Medical Biotechnologies, University of Siena, Italy
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12
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Truong VT, Phan HT, Pham KN, Duong HN, Ngo TN, Palmer C, Nguyen TT, Truong BH, Vo MA, Tretter JT, Nagueh SF, Chung ES, Mazur W. Normal Ranges of Left Ventricular Strain by Three-Dimensional Speckle-Tracking Echocardiography in Adults: A Systematic Review and Meta-Analysis. J Am Soc Echocardiogr 2019; 32:1586-1597.e5. [DOI: 10.1016/j.echo.2019.07.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/16/2019] [Accepted: 07/08/2019] [Indexed: 12/21/2022]
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13
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Tadic M, Cuspidi C, Suzic‐Lazic J, Andric A, Sala C, Santoro C, Iracek O, Celic V. Influence of circadian blood pressure patterns and cardiopulmonary functional capacity in hypertensive patients. J Clin Hypertens (Greenwich) 2019; 21:1551-1557. [DOI: 10.1111/jch.13671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 12/17/2022]
Affiliation(s)
- Marijana Tadic
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
- Department of Internal Medicine and Cardiology Charité – Universitätsmedizin Berlin Berlin Germany
| | - Cesare Cuspidi
- Clinical Research Unit University of Milan‐Bicocca and Istituto Auxologico Italiano IRCCS Meda Italy
| | - Jelena Suzic‐Lazic
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Anita Andric
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Carla Sala
- Clinical Research Unit University of Milan‐Bicocca and Istituto Auxologico Italiano IRCCS Meda Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences Federico II University Hospital Naples Italy
| | - Olinka Iracek
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Vera Celic
- Department of Cardiology University Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
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14
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Concomitant systolic and diastolic alterations during chronic hypertension in pig. J Mol Cell Cardiol 2019; 131:155-163. [PMID: 31051181 DOI: 10.1016/j.yjmcc.2019.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/19/2019] [Accepted: 04/28/2019] [Indexed: 11/23/2022]
Abstract
The mechanical and cellular relationships between systole and diastole during left ventricular (LV) dysfunction remain to be established. LV contraction-relaxation coupling was examined during LV hypertrophy induced by chronic hypertension. Chronically instrumented pigs received angiotensin II infusion for4weeks to induce chronic hypertension (133 ± 7 mmHg vs 98 ± 5 mmHg for mean arterial pressure at Day 28 vs 0, respectively) and LV hypertrophy. LV function was investigated with the instrumentation and echocardiography for LV twist-untwist assessment before and after dobutamine infusion. The cellular mechanisms were investigated by exploring the intracellular Ca2+ handling. At Day 28, pigs exhibited LV hypertrophy with LV diastolic dysfunction (impaired LV isovolumic relaxation, increased LV end-diastolic pressure, decreased and delayed LV untwisting rate) and LV systolic dysfunction (impaired LV isovolumic contraction and twist) although LV ejection fraction was preserved. Isolated cardiomyocytes exhibited altered shortening and lengthening. Interestingly, contraction-relaxation coupling remained preserved both in vivo and in vitro during LV hypertrophy. LV systolic and diastolic dysfunctions were associated to post-translational remodeling and dysfunction of the type 2 cardiac ryanodine receptor/Ca2+ release channel (RyR2), i.e., PKA hyperphosphorylation of RyR2, depletion of calstabin 2 (FKBP12.6), RyR2 leak and hypersensitivity of RyR2 to cytosolic Ca2+ during both contraction and relaxation phases. In conclusion, LV contraction-relaxation coupling remained preserved during chronic hypertension despite LV systolic and diastolic dysfunctions. This implies that LV diastolic dysfunction is accompanied by LV systolic dysfunction. At the cellular level, this is linked to sarcoplasmic reticulum Ca2+ leak through PKA-mediated RyR2 hyperphosphorylation and depletion of its stabilizing partner.
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Cameli M, Mandoli GE, Sciaccaluga C, Mondillo S. More than 10 years of speckle tracking echocardiography: Still a novel technique or a definite tool for clinical practice? Echocardiography 2019; 36:958-970. [DOI: 10.1111/echo.14339] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 03/20/2019] [Accepted: 03/21/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular DiseasesUniversity of Siena Siena Italy
| | - Giulia E. Mandoli
- Department of Cardiovascular DiseasesUniversity of Siena Siena Italy
| | | | - Sergio Mondillo
- Department of Cardiovascular DiseasesUniversity of Siena Siena Italy
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16
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Kotini-Shah P, Cuadros S, Huang F, Colla JS. Strain analysis for the identification of hypertensive cardiac end-organ damage in the emergency department. Crit Ultrasound J 2018; 10:29. [PMID: 30450528 PMCID: PMC6240555 DOI: 10.1186/s13089-018-0110-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/17/2018] [Indexed: 11/23/2022] Open
Abstract
Hypertensive emergency is a life-threatening state. End-organ damage affecting the heart accounts for up to 52% of hypertensive emergencies commonly encountered in the emergency department. Recent evidence indicates that strain echocardiography with computerized speckle-tracking is more sensitive at identifying hypertension induced changes in the left ventricle (LV) mechanical function than traditional 2-D echocardiography. We present a case demonstrating the use of emergency physician performed point-of-care strain echocardiography to identify and quantify LV mechanical dysfunction during a hypertensive crisis and to monitor improvement over 6 h.
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Affiliation(s)
- Pavitra Kotini-Shah
- Department of Emergency Medicine, University of Illinois at Chicago, 808 S. Wood Street (MC 724), Chicago, IL, 60612, USA.
| | - Susana Cuadros
- University of Illinois at Chicago, College of Medicine, Chicago, USA
| | - Felix Huang
- Department of Emergency Medicine, University of Illinois at Chicago, 808 S. Wood Street (MC 724), Chicago, IL, 60612, USA
| | - Joseph S Colla
- Department of Emergency Medicine, University of Illinois at Chicago, 808 S. Wood Street (MC 724), Chicago, IL, 60612, USA
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17
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Tadic M, Cuspidi C. Diuretics and left ventricular hypertrophy regression: The relationship that we commonly forget. J Clin Hypertens (Greenwich) 2018; 20:1516-1518. [PMID: 30251479 DOI: 10.1111/jch.13381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
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Tadic M, Cuspidi C, Bombelli M, Grassi G. Right heart remodeling induced by arterial hypertension: Could strain assessment be helpful? J Clin Hypertens (Greenwich) 2018; 20:400-407. [PMID: 29370476 DOI: 10.1111/jch.13186] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 10/22/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
Left ventricular structural and functional changes in patients with arterial hypertension are well established. However, the influence of arterial hypertension on right ventricular (RV) remodeling is still being investigated. The introduction of strain analysis provided an insight into RV function and mechanics. Previous research has demonstrated the predictive value of RV longitudinal strain in patients with various cardiovascular conditions, such as pulmonary hypertension, heart failure, congenital heart diseases, and valvular disease. Nowadays, we are aware of the fact that conventional echocardiographic methods usually do not provide necessary information about RV dysfunction in patients with arterial hypertension, which is why the evaluation of new parameters that could detect RV subtle changes in hypertension is essential. The present review article is an overview of the main principles of RV deformation and a summary of the current knowledge and clinical significance of RV strain in patients with arterial hypertension.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Cesare Cuspidi
- Clinical Research Unit, Istituto Auxologico Italiano, University of Milan-Bicocca, Meda, Italy
| | - Michele Bombelli
- Department of Health Science, University of Milano-Bicocca, Milano, Italy
| | - Guido Grassi
- Department of Health Science, University of Milano-Bicocca, Milano, Italy.,Department of Clinical Sciences and Community Health, Fondazione Ospedale Maggiore Policlinico di Milano, University of Milano, Milano, Italy
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20
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Preserved Myocardial Deformation after Successful Coarctation Repair: A CMR Feature-Tracking Study. Pediatr Cardiol 2018; 39:555-564. [PMID: 29209744 PMCID: PMC5829108 DOI: 10.1007/s00246-017-1788-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 12/01/2017] [Indexed: 12/28/2022]
Abstract
Arterial vasculopathy and residual aortic obstruction can lead to left ventricular (LV) dysfunction in patients with coarctation of the aorta (CoA) related to adverse ventriculo-arterial coupling. This study aimed to investigate potential differences in LV myocardial deformation indices between repaired CoA patients and healthy controls. Twenty-two CoA patients (age 30 ± 10.6 years) after surgical repair (n = 12) or balloon angioplasty (BA) (n = 10) without residual stenosis, between 3 months and 16 years of age with > 10 years follow-up were compared to 22 healthy age- and gender-matched controls (age 30 ± 3.8 years). Cardiac magnetic resonance feature tracking (CMR-FT) was used for LV longitudinal-, circumferential-, and rotational deformation indices. Global systolic LV function was preserved in CoA patients (LV ejection fraction 58 ± 4.8 vs. 60 ± 6.8%, p = 0.56) when compared to controls, with normal LV dimensions and mass (p > 0.05). Twelve CoA patients (55%) were hypertensive, of whom 4 were on anti-hypertensive medication. LV global longitudinal strain was preserved in the four-chamber (- 18 ± 4.4 vs. - 16 ± 4.7%, p = 0.06) and two-chamber (- 22 ± 5.1 vs. - 20 ± 6.0%, p = 0.22) orientations in CoA patients. Global circumferential strain was preserved at basal (- 29 ± 4.1 vs. - 28 ± 4.8%, p = 0.43), mid-ventricular (- 27 ± 4.2 vs. - 25 ± 3.0%, p = 0.09), and apical levels (- 35 ± 7.8 vs. - 32 ± 34.9%, p = 0.32). No differences were found in global torsion (2.4 ± 1.3° vs. 2.0 ± 1.4°/cm, p = 0.28), twist (14 ± 5.8° vs. 12 ± 6.3°, p = 0.34), and recoil rate (- 17 ± 9.7° vs. - 17 ± 7.1°/cm s, p = 0.97). Analysis of intra-observer variability demonstrated good reproducibility for all CMR deformation indices. Global and rotational myocardial deformation indices are preserved in CoA patients long-term after repair without residual stenosis, despite a high incidence of hypertension.
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21
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Cusmà Piccione M, Zito C, Khandheria B, Madaffari A, Oteri A, Falanga G, Donato D, D'Angelo M, Carerj ML, Di Bella G, Imbalzano E, Pugliatti P, Carerj S. Cardiovascular maladaptation to exercise in young hypertensive patients. Int J Cardiol 2017; 232:280-288. [DOI: 10.1016/j.ijcard.2017.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 12/27/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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22
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Chang WT, Chen JS, Tsai MH, Tsai WC, Juang JN, Liu PY. Interplay of Aging and Hypertension in Cardiac Remodeling: A Mathematical Geometric Model. PLoS One 2016; 11:e0168071. [PMID: 27977729 PMCID: PMC5158006 DOI: 10.1371/journal.pone.0168071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/27/2016] [Indexed: 02/04/2023] Open
Abstract
Hypertensive disorder can cause cardiac deformities. Elastic characteristic parameters, like Young’s modulus of elasticity (E) derived from a traditional cylindrical model, increase significantly with aging. However, the geometric and component changes of aging hearts because of chronic hypertension remain unknown. To better describe the effects, we propose an elliptical elastic and mathematical model to evaluate myocardial stiffness. Ninety-six hypertensive patients (HTNPos) (men: 59.3%; age ≥ 65 years: 20.8%) were enrolled and compared with normotensive controls (HTNNeg) (n = 47, 48.9%). HTNPos patients had a thicker interventricular septum in diastole (IVSd) (HTNPos: 0.96 ± 0.21 cm vs. HTNNeg: 0.77 ± 0.15; p = 0.005) and higher intracardiac pressure (e/e′: 9.06 ± 4.85 cm vs. 7.76 ± 3.41; p = 0.01), especially the elderly (> 65 years) (IVSd: 1.03 ± 0.19 cm, e/e′: 11.39 ± 1.99; p = 0.006 and 0.01, respectively). Nevertheless, the internal dimension decreased more significantly in the HTNPos rather than in the HTNNeg elderly (5.23 ± 0.46 vs. 4.74 ± 0.69 cm; p = 0.02). We found different directions of cardiac remodeling with normotensive and hypertensive loads. Different from the longitudinal and circumferential strain, E and Poisson’s ratio (υ) are values that directly present the rigidity of myocardium. E was significantly higher in the elderly (8011.92 ± 2431.85 vs. 6052.43 ± 3121.50; p = 0.02), whereas υ was significantly higher in all HTNPos patients (0.73 ± 0.12 vs. 0.61 ± 0.07; p < 0.001). Because E and υ reflected the material changes of myocardium in the HTNPos elderly, the proposed elliptical mathematical heart model better describes the geometric deformity induced by aging and hypertension.
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Affiliation(s)
- Wei-Ting Chang
- Division of Cardiology, Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Engineering Science, National Cheng Kung University, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jung-San Chen
- Department of Engineering Science, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Hang Tsai
- Department of Engineering Science, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Chuan Tsai
- Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jer-Nan Juang
- Department of Engineering Science, National Cheng Kung University, Tainan, Taiwan
- * E-mail: (PYL); (JNJ)
| | - Ping-Yen Liu
- Division of Cardiology, Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, China Medical University, Taichung, Taiwan
- * E-mail: (PYL); (JNJ)
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23
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Cinotti R, Piriou N, Launey Y, Le Tourneau T, Lamer M, Delater A, Trochu JN, Brisard L, Lakhal K, Bourcier R, Desal H, Seguin P, Mallédant Y, Blanloeil Y, Feuillet F, Asehnoune K, Rozec B. Speckle tracking analysis allows sensitive detection of stress cardiomyopathy in severe aneurysmal subarachnoid hemorrhage patients. Intensive Care Med 2016; 42:173-82. [PMID: 26499884 DOI: 10.1007/s00134-015-4106-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 05/04/2015] [Indexed: 01/01/2023]
Abstract
PURPOSE Stress cardiomyopathy is a common life-threatening complication after aneurysmal subarachnoid hemorrhage (SAH). We hypothesized that left ventricular (LV) longitudinal strain alterations assessed with speckle tracking could identify early systolic function impairment. METHODS This was an observational single-center prospective pilot controlled study conducted in a neuro-intensive care unit. Forty-six patients with severe SAH with a World Federation of Neurological Surgeons grade (WFNS) ≥ III were included. Transthoracic echocardiography (TTE) was performed on day 1, day 3, and day 7 after the patient's admission. A cardiologist blinded to the patient's management analyzed the LV global longitudinal strain (GLS). The control group comprised normal subjects matched according to gender and age. RESULTS On day 1 median (25th-75th percentile) GLS was clearly impaired in SAH patients compared to controls [-16.7 (-18.7/-13.7) % versus -20 (-22/-19) %, p < 0.0001], whereas LVEF was preserved [65 (59-70) %]. GLS was severely impaired in patients with a WFNS score of V versus III-IV [-15.6 (-16.9/-12.3) % versus -17.8 (-20.6/-15.8) %, p = 0.008]. Seventeen (37 %) patients had a severe GLS alteration (>- 16 %). In these patients, GLS improved from day 1 [-12.4 (-14.8/-10.9) %] to last evaluation [-16.2 (-19/-14.6) %, p = 0.0007] in agreement with the natural evolution of stress cardiomyopathy. CONCLUSIONS On the basis of LV GLS assessment, we demonstrated for the first time that myocardial alteration compatible with a stress cardiomyopathy is detectable in up to 37 % of patients with severe SAH while LVEF is preserved. GLS could be used for sensitive detection of stress cardiomyopathy. This is critical because cardiac impairment remains a major cause of morbidity and mortality after SAH.
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Tadic M, Cuspidi C, Vukomanovic V, Celic V, Tasic I, Stevanovic A, Kocijancic V. Does masked hypertension impact left ventricular deformation? ACTA ACUST UNITED AC 2016; 10:694-701. [PMID: 27461398 DOI: 10.1016/j.jash.2016.06.032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/24/2016] [Accepted: 06/15/2016] [Indexed: 10/21/2022]
Abstract
Our aim was to compare left ventricular (LV) deformation in subjects with masked hypertension (MH) to normotensive and sustained hypertensive patients. This cross-sectional study included 185 untreated subjects who underwent 24-hour ambulatory blood pressure (BP) monitoring and complete two-dimensional echocardiographic (2DE) examination including multilayer strain analysis. MH was diagnosed if clinic BP was normal (<140/90 mm Hg), and 24-hour BP was increased (≥130/80 mm Hg). 2DE LV longitudinal and circumferential strains gradually and significantly decreased from normotensive controls across MH individuals to sustained hypertensive patients. 2DE radial strain was not different between groups. 2DE longitudinal and circumferential endocardial and midmyocardial layer strains progressively decreased from normotensive control to sustained hypertensive individuals. Longitudinal and circumferential epicardial layer strains were lower in sustained hypertensive patients than in normotensive controls. Clinic and 24-hour systolic BP were associated with 2DE LV longitudinal endocardial strain, midmyocardial strain, and 2DE circumferential endocardial strain in the whole-study population independent of LV structure and diastolic function. MH significantly affect LV deformation assessed by 2DE traditional strain and 2DE multilayer strain. Clinic and 24-hour systolic BP were associated with LV mechanics evaluated with comprehensive 2DE strain analysis independent of LV structure and diastolic function.
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Affiliation(s)
- Marijana Tadic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia; School of Medicine, Belgrade University, Belgrade, Serbia.
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
| | - Vladan Vukomanovic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Vera Celic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia; School of Medicine, Belgrade University, Belgrade, Serbia
| | - Ivan Tasic
- School of Medicine, University of Nis, Nis, Serbia
| | - Ana Stevanovic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia
| | - Vesna Kocijancic
- Cardiology Department, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Belgrade, Serbia
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25
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Cramariuc D, Gerdts E. Epidemiology of left ventricular hypertrophy in hypertension: implications for the clinic. Expert Rev Cardiovasc Ther 2016; 14:915-26. [DOI: 10.1080/14779072.2016.1186542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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26
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Yang H, Wang Y, Negishi K, Nolan M, Marwick TH. Pathophysiological effects of different risk factors for heart failure. Open Heart 2016; 3:e000339. [PMID: 27042319 PMCID: PMC4800761 DOI: 10.1136/openhrt-2015-000339] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Revised: 12/07/2015] [Accepted: 01/08/2016] [Indexed: 01/28/2023] Open
Abstract
Background Hypertension and type 2 diabetes mellitus (T2DM) are important causes of non-ischaemic heart failure (HF). Understanding the pathophysiology of early HF may guide screening. We hypothesised that the underlying physiology differed according to aetiology. Methods In this cross-sectional study of 521 asymptomatic community-based subjects ≥65 years with ≥1 HF risk factors, 187 participants (36%) had T2DM and hypertension (T2DM+/HTN+), 109 (21%) had T2DM with no hypertension (T2DM+/HTN−) and 72 (14%) had neither T2DM nor hypertension (T2DM−/HTN−). In 153 patients (29%), clinic blood pressure was ≥140/90 mm Hg, defined as active hypertension (T2DM−/HTN+). All underwent a comprehensive echocardiogram, including conventional parameters for systolic and diastolic function as well as global longitudinal strain (GLS), diastolic strain (DS) and DS rate (DSR). A 6 min walk (6MW) test was used to assess functional capacity. Results GLS in T2DM−/HTN+ group (−18.9±2.7%) was similar to that in T2DM−/HTN− group (−19.4±2.4%) and greater than T2DM+/HTN− (−18.0±2.8%, p=0.005). DS in T2DM−/HTN− (0.47±0.15%) exceeded that in T2DM−/HTN+ (0.43±0.14%) and T2DM+/HTN− (0.43±0.13%). 6MW distance was preserved in T2DM−/HTN+ (482±85 m) and reduced in T2DM+/HTN− (469±93, p<0.001). Those with T2DM and active hypertension had worst GLS, DS, DSR and shortest 6MW distance (p<0.002). In multivariable analysis, GLS was associated with T2DM but neither active hypertension nor a history of hypertension. Diastolic markers and left ventricular (LV) mass were associated with hypertension and T2DM. Thus, patients with HF risk factors show different functional disturbances according to aetiology. Conclusions Patients with hypertension had relatively less impaired GLS and preserved 6MW distance but more impaired diastolic function.
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Affiliation(s)
- Hong Yang
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
| | - Ying Wang
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
| | - Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
| | - Mark Nolan
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania , Hobart, Tasmania , Australia
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Ma H, Xie RA, Gao LJ, Zhang JP, Wu WC, Wang H. Prediction of Left Ventricular Filling Pressure by 3-Dimensional Speckle-Tracking Echocardiography in Patients With Coronary Artery Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2015; 34:1809-1818. [PMID: 26333567 DOI: 10.7863/ultra.15.14.11010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 01/12/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the diagnostic value of 3-dimensional (3D) speckle-tracking echocardiography for estimating left ventricular filling pressure in patients with coronary artery disease (CAD) and a preserved left ventricular ejection fraction. METHODS Altogether, 84 patients with CAD and 30 age- and sex-matched healthy control participants in sinus rhythm were recruited prospectively. All participants underwent conventional and 3D speckle-tracking echocardiography. Global strain values were automatically calculated by 3D speckle-tracking analysis. The left ventricular end-diastolic pressure (LVEDP) was determined invasively by left heart catheterization. Echocardiography and cardiac catheterization were performed within 24 hours. RESULTS Compared with the controls, patients with CAD showed lower global longitudinal strain, global circumferential strain, global area strain, and global radial strain. Patients with CAD who had an elevated LVEDP had much lower levels of all 4 3D-speckle-tracking echocardiographic variables. Pearson correlation analysis revealed that the LVEDP correlated positively with the early transmitral flow velocity/early diastolic myocardial velocity (E/E') ratio, global longitudinal strain, global circumferential strain, and global area strain. It correlated negatively with global radial strain. Receiver operating characteristic curve analysis revealed that these 3D speckle-tracking echocardiographic indices could effectively predict elevated left ventricular filling pressure (LVEDP >15 mm Hg) in patients with CAD (areas under the curve: global longitudinal strain, 0.78; global radial strain, 0.77; global circumferential strain, 0.75; and global area strain, 0.74). These parameters, however, showed no advantages over the commonly used E/E' ratio (area under the curve, 0.84). CONCLUSIONS Three-dimensional speckle-tracking echocardiography was a practical technique for predicting elevated left ventricular filling pressure, but it might not be superior to the commonly used E/E' ratio in patients with CAD who have a normal left ventricular ejection fraction.
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Affiliation(s)
- Hong Ma
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.)
| | - Rong-Ai Xie
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.)
| | - Li-Jian Gao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.)
| | - Jin-Ping Zhang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.)
| | - Wei-Chun Wu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.).
| | - Hao Wang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (H.M., L.-J.G., J.P.Z., W.-C.W., H.W.); and Department of Cardiology, Peking University Shougang Hospital, Beijing, China (R.-A.X.).
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Besli F, Basar C, Ekinozu I, Turker Y. Relationship Between Tei Index and PEP-Derived Myocardial Performance Index in Sinus Rhythm. Medicine (Baltimore) 2015; 94:e1112. [PMID: 26200613 PMCID: PMC4602998 DOI: 10.1097/md.0000000000001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The goal of this study was to evaluate the preejection time (PEP)-derived myocardial performance index (MPI) in hypertensive (HT) patients with sinus rhythm and its relationship to the classic Tei index. One hundred five patients were enrolled in the study (65 HT and 40 control subjects). The mean age of all patients was 50.5 ± 15 years and 60% were female. Echocardiography was performed on all patients. MPI was measured with the classic Tei method (MPI-Tei index) and the PEP-derived MPI method by using tissue Doppler echocardiography. Although the MPI-Tei index is defined as the ratio of isovolumetric contraction time (IVCT) along with isovolumetric relaxation time (IVRT) to ejection time (ET), PEP-derived MPI is defined as the ratio of PEP and IVRT to ET. We compared echocardiographic data between the HT group and the control group. MPI-Tei index and the PEP-derived MPI values were higher in the HT group compared with controls (0.52 ± 0.10 vs 0.39 ± 0.07, P < 0.001, and 0.51 ± 0.09 vs 0.39 ± 0.07). PEP-derived MPI was strongly correlated with the MPI-Tei index (r = 0.945, P < 0.001). Our study determined that the PEP-derived MPI might be used in the evaluation of left ventricular function in patients with HT, similar to the classic MPI-Tei index.
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Affiliation(s)
- Feyzullah Besli
- From the Department of Cardiology (FB), Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa; Department of Cardiology (CB), Duzce Ataturk State Hospital; and Department of Cardiology (IE, YT), Duzce University Faculty of Medicine Hospital, Duzce, Turkey
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Krzesiński P, Uziębło-Życzkowska B, Gielerak G, Stańczyk A, Kurpaska M, Piotrowicz K. Global longitudinal two-dimensional systolic strain is associated with hemodynamic alterations in arterial hypertension. ACTA ACUST UNITED AC 2015; 9:680-9. [PMID: 26233299 DOI: 10.1016/j.jash.2015.06.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Revised: 06/15/2015] [Accepted: 06/22/2015] [Indexed: 11/17/2022]
Abstract
Arterial hypertension can lead to the progressive deterioration of the left ventricular (LV) performance. The aim of this study was to estimate the relation of global longitudinal systolic strain (GLSS) with central and systemic hemodynamics assessed by applanation tonometry and impedance cardiography in 125 hypertensive patients. Those with more impaired GLSS characterized with 1/worse diastolic function (mitral inflow early phase (E) to mitral septal annulus early diastolic velocity (e') ratio, 8.0 vs. 7.0, P = .014); 2/lower LV performance (cardiac index, 3.14 vs. 3.64 l/min/m(2); P = .007), and 3/higher afterload (systemic vascular resistance index, 2506 vs. 2107 dyn s m(2)/cm(5); P = .008). No relevant differences in, that is, gender, age, blood pressure, LV mass index, left chambers dimensions, and central blood pressure characteristics were identified. The results revealed that impaired GLSS is related to LV diastolic dysfunction and altered hemodynamics which may be markers of early systolic LV dysfunction related to arterial hypertension.
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Affiliation(s)
- Paweł Krzesiński
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland.
| | | | - Grzegorz Gielerak
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Adam Stańczyk
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Małgorzata Kurpaska
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
| | - Katarzyna Piotrowicz
- Department of Cardiology and Internal Diseases, Military Institute of Medicine, Warsaw, Poland
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Mihaila S, Mincu RI, Rimbas RC, Dulgheru RE, Dobrescu R, Magda SL, Badiu C, Vinereanu D. Growth Hormone Deficiency in Adults Impacts Left Ventricular Mechanics: A Two-Dimensional Speckle-Tracking Study. Can J Cardiol 2015; 31:752-9. [DOI: 10.1016/j.cjca.2015.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 01/12/2015] [Accepted: 01/12/2015] [Indexed: 11/29/2022] Open
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Omar AMS, Vallabhajosyula S, Sengupta PP. Left Ventricular Twist and Torsion. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.115.003029. [DOI: 10.1161/circimaging.115.003029] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Alaa Mabrouk Salem Omar
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Sharath Vallabhajosyula
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Partho P. Sengupta
- From the Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY
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Tadic M, Cuspidi C, Pencic B, Pavlovic SU, Ivanovic B, Kocijancic V, Celic V. Association between left ventricular mechanics and heart rate variability in untreated hypertensive patients. J Clin Hypertens (Greenwich) 2015; 17:118-25. [PMID: 25496306 PMCID: PMC8031630 DOI: 10.1111/jch.12459] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 10/26/2014] [Accepted: 10/28/2014] [Indexed: 12/17/2022]
Abstract
The authors sought to investigate left ventricular (LV) mechanics and heart rate variability (HRV), and their relationship, in untreated hypertensive patients. A total of 63 untreated hypertensive patients and 45 healthy patients were included. All patients underwent 24-hour Holter monitoring and echocardiographic examination (two- and three-dimensional). All parameters of time and frequency domain of HRV were decreased in the hypertensive patients. Two-dimensional LV longitudinal and circumferential deformation was significantly reduced in hypertensive patients. Three-dimensional LV strain in all three directions as well as area strain were reduced in the hypertensive group. In two different models of multivariate regression, two-dimensional LV longitudinal and circumferential strain, as well as three-dimensional LV area strain, remained associated with HRV parameters independently of LV structural and functional parameters. This study showed that LV mechanics and HRV were significantly impaired in untreated hypertensive patients. Two- and three-dimensional echocardiographic LV deformation were independently associated with HRV parameters in the whole study population.
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Affiliation(s)
- Marijana Tadic
- Department of CardiologyUniversity Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje”BelgradeSerbia
| | - Cesare Cuspidi
- Clinical Research UnitUniversity of Milan‐Bicocca and Istituto Auxologico ItalianoMedaItaly
| | - Biljana Pencic
- Department of CardiologyUniversity Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje”BelgradeSerbia
- Faculty of MedicineBelgradeSerbia
| | - Sinisa U. Pavlovic
- Clinical Center of SerbiaPacemaker CenterBelgradeSerbia
- Faculty of MedicineBelgradeSerbia
| | - Branislava Ivanovic
- Faculty of MedicineBelgradeSerbia
- Clinical Center of SerbiaClinic of CardiologyBelgradeSerbia
| | - Vesna Kocijancic
- Department of CardiologyUniversity Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje”BelgradeSerbia
| | - Vera Celic
- Department of CardiologyUniversity Clinical Hospital Center “Dr. Dragisa Misovic ‐ Dedinje”BelgradeSerbia
- Faculty of MedicineBelgradeSerbia
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Seo Y, Ishizu T, Atsumi A, Kawamura R, Aonuma K. Three-Dimensional Speckle Tracking Echocardiography. Circ J 2014; 78:1290-301. [DOI: 10.1253/circj.cj-14-0360] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Tomoko Ishizu
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Akiko Atsumi
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Ryo Kawamura
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
| | - Kazutaka Aonuma
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba
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