1
|
Cagan Efe S, Buğrahan Cicek M, Unkun T, Yucel E, Karagöz A, Doğan C, Bayram Z, Tekatlı AF, Bozan B, Karaçam M, Halil GS, Karabağ T, Kaymaz C, Ozdemir N. Usability of myocardial work parameters to demonstrate subclinical myocardial involvement in normotensive individuals with exaggerated hypertensive response in treadmill exercise testing. J Clin Hypertens (Greenwich) 2024; 26:687-695. [PMID: 38605567 PMCID: PMC11180695 DOI: 10.1111/jch.14814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/13/2024]
Abstract
Early determination of changes in myocardial functions is essential for the protection of cardiovascular diseases. This study aimed to evaluate myocardial work parameters in healthy individuals who developed an exaggerated hypertensive response during the treadmill exercise test procedure. The study included a total of 64 patients for whom an exercise electrocardiography test was planned for functional capacity evaluation. The study population was divided according to the presence of exaggerated hypertensive response to exercise (EBPRE) (SBP/DBP ≥210/105 mmHg in males ≥190/105 mmHg in females) and normal blood pressure response to exercise (NBPRE). Patients' echocardiographic evaluations were made at rest, and myocardial work parameters were calculated. There was no statistical difference between the groups (NBPRE vs. EBPRE, respectively) in terms of left ventricular 2,3 and 4 chamber strains and global longitudinal strain (GLS) values (-20.6 ± -2.3, -19.7 ± -1.9, p:.13; -21.3 ± -2.7, -21 ± -2.4, p:.68; -21.2 ± -2.2, -21.2 ± -2.3, p:.93; and -20.8 ± -1.5, -20.4 ± -1.5, p:.23, respectively). Global constrictive work (GCW), global waste work (GWW), and global work efficiency (GWE) were not statistically different between the two groups (2374 ± 210, 2465 ± 204, p:.10; 142 ± 64, 127 ± 42, p:.31; 94.3 ± 2.5, 95.1 ± 1.5, p:.18, respectively). In contrast, global work index (GWI) parameters were different between the two groups (2036 ± 149, 2147 ± 150, p < .001). The GWI was independently associated with EBPRE (odds ratio with 95% 3.32 (1.02-11.24), p = .03). The partial effect plots were used for GWI to predict EBPRE, according to the results, an increase in GWI predicts probability of exaggerated hypertensive response. In conclusion, Myocardial work analyses might be used to identify early signs of myocardial involvement in normotensive patients with EBPRE.
Collapse
Affiliation(s)
- Süleyman Cagan Efe
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Mahmut Buğrahan Cicek
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Tuba Unkun
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Enver Yucel
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Ali Karagöz
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Cem Doğan
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Zübeyde Bayram
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Ali Furkan Tekatlı
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Baver Bozan
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Murat Karaçam
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Gülümser Sevgin Halil
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Turgut Karabağ
- Department of CardiologyIstanbul Education and Research HospitalIstanbulTurkey
| | - Cihangir Kaymaz
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| | - Nihal Ozdemir
- Department of CardiologyKartal Kosuyolu Education and Research HospitalIstanbulTurkey
| |
Collapse
|
2
|
Wiech P, Würzburger L, Rossi VA, Caselli S, Schmied CM, Niederseer D. Hypertensive response to exercise, hypertension and heart failure with preserved ejection fraction (HFpEF)-a continuum of disease? Wien Klin Wochenschr 2023; 135:685-695. [PMID: 37069407 PMCID: PMC10713678 DOI: 10.1007/s00508-023-02195-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 03/05/2023] [Indexed: 04/19/2023]
Abstract
INTRODUCTION Heart failure with preserved ejection fraction (HFpEF) has been shown to be a long-term consequence of uncontrolled arterial hypertension (aHT). Other than that, hypertensive response to exercise (HRE) precedes aHT. We aim to evaluate the available evidence for a continuum of HRE, aHT and HFpEF. METHODS A literature search on PubMed was conducted to assembly the most recent data on the topic. After collecting the data, a qualitative analysis was instrumented. RESULTS 10 studies including 16,165 subjects were analyzed with respect to the association between HRE and the future risk of developing aHT. With the exception of one study, all reported on a positive association between HRE and the future development of aHT despite methodological issues related to different definitions for HRE. Furthermore, HRE was associated with an increased risk of coronary artery disease. Moreover, we analysed 6 studies including overall 1366 subjects investigating the association between HRE and HFpEF. In these studies, increased left atrial volume index (LAVI), elevated E/e' (as surrogate parameters of increased LV end-diastolic filling pressure and of diastolic dysfunction) and higher LV mass index have been proposed as independent predictor of HRE in patients with no known HFpEF diagnosis. DISCUSSION AND CONCLUSION The literature search revealed suggestive data on a connection of HRE, aHT and HFpEF. HRE seems to be an independent risk factor for aHT and aHT in turn is one of the main risk factors for HFpEF. However, further research is needed to improve our knowledge of a possible continuum of disease.
Collapse
Affiliation(s)
- Patrick Wiech
- Department of Cardiology, University Hospital Zurich, University Heart Center Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Laura Würzburger
- Department of Cardiology, University Hospital Zurich, University Heart Center Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Valentina A Rossi
- Department of Cardiology, University Hospital Zurich, University Heart Center Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - Stefano Caselli
- Hirslanden, Klinik im Park, Cardiovascular Center Zurich, Zurich, Switzerland
| | - Christian M Schmied
- Department of Cardiology, University Hospital Zurich, University Heart Center Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, University Heart Center Zurich, University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
| |
Collapse
|
3
|
Hypertensive Response to Exercise in Athletes: Unremarkable Finding or Relevant Marker for Future Cardiovascular Complications? Int J Hypertens 2022; 2022:8476751. [DOI: 10.1155/2022/8476751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/23/2022] [Accepted: 06/29/2022] [Indexed: 11/22/2022] Open
Abstract
Background. In the general population, hypertensive response to exercise (HRE) predicts new-onset resting hypertension or other cardiovascular diseases. Methods. PubMed was searched for English articles published between January 1st 2000 and April 30th 2020. Additional studies were identified via reference lists of included studies. 92 papers were selected for full text analysis, finally 30 studies were included. Results. The results from 5 follow-up studies suggested an association between HRE and the risk of developing hypertension, while 10 studies reported a link with adverse cardiovascular events in the general population. Another study showed an association between HRE and future hypertension in athletes after a follow-up of 7 years. HRE in athletes was associated with left ventricular hypertrophy in three studies. Two other studies showed a link between HRE and focal myocardial fibrosis in triathletes and myocardial injury, respectively. One study found lower Apoliprotein-1 serum levels in athletes with HRE leading to a higher risk for cardiovascular disease. Only in one study no association with cardiovascular dysfunction in athletes with HRE was found. Conclusions. Based on current evidence, HRE is not a normal finding in athletes. If detected, it should be interpreted as a risk factor for future cardiovascular complications. Future research should address the adequate follow-up and management of athletes with HRE.
Collapse
|
4
|
Saeed S, Chambers JB. Exercise Testing in Aortic Stenosis: Safety, Tolerability, Clinical Benefits and Prognostic Value. J Clin Med 2022; 11:jcm11174983. [PMID: 36078911 PMCID: PMC9457179 DOI: 10.3390/jcm11174983] [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: 07/05/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Routine exercise testing in asymptomatic patients with valvular heart disease (VHD) better classifies the hemodynamic severity of valve stenosis or regurgitation, and describes the symptomatic status and functional capacity of the patient. This is crucial for planned surveillance and optimal timing of surgery, particularly for aortic stenosis (AS), because once symptoms occur, there is a sharp increase in the risk of sudden death unless valve intervention is performed. Purpose: To conduct a focused clinical review on the benefits of exercise testing in patients with AS. Methods: The electronic database PubMed was systematically searched for relevant retrospective and prospective cohort studies reporting on the safety, feasibility and tolerability of exercise testing in VHD, with a special focus on AS. Results and conclusions: In patients with significant AS, exercise testing is safe, feasible and reveals symptoms in a significant proportion of patients. In addition, serial testing has incremental prognostic value over a baseline test alone. Exercise testing in patients with AS is underused and should be performed routinely to refine the hemodynamic severity of AS.
Collapse
Affiliation(s)
- Sahrai Saeed
- Department of Heart Disease, Haukeland University Hospital, 5021 Bergen, Norway
- Correspondence:
| | - John B. Chambers
- Cardiothoracic Centre, Guy’s and Saint Thomas’ Hospital, London SE1 9RS, UK
| |
Collapse
|
5
|
Coronary flow velocity reserve is reduced in patients with an exaggerated blood pressure response to exercise. Hypertens Res 2022; 45:1653-1663. [DOI: 10.1038/s41440-022-00995-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/18/2022] [Accepted: 06/23/2022] [Indexed: 11/09/2022]
|
6
|
Zeng S, Dunn M, Gold WM, Kizer JR, Arjomandi M. Remote exposure to secondhand tobacco smoke is associated with lower exercise capacity through effects on oxygen pulse, a proxy of cardiac stroke volume. BMJ Open Respir Res 2022; 9:e001217. [PMID: 35551073 PMCID: PMC9109127 DOI: 10.1136/bmjresp-2022-001217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/22/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Past exposure to secondhand tobacco smoke (SHS) is associated with exercise limitation. Pulmonary factors including air trapping contribute to this limitation but the contribution of cardiovascular factors is unclear. OBJECTIVE To determine the contribution of cardiovascular mechanisms to SHS-associated exercise limitation. METHODS We examined the cardiovascular responses to maximum-effort exercise in 245 never-smokers with remote, prolonged occupational exposure to SHS and no known history of cardiovascular disease. We estimated the contribution of oxygen-pulse (proxy for cardiac stroke volume) and changes in systolic blood pressures (SBP), diastolic blood pressures and heart rate (HR) towards exercise capacity, and examined whether the association of SHS with exercise capacity was mediated through these variables. RESULTS At peak exercise (highest workload completed (WattsPeak)=156±46 watts (135±33 %predicted)), oxygen consumption and oxygen-pulse (O2-PulsePeak) were 1557±476 mL/min (100±24 %predicted) and 11.0±3.0 mL/beat (116±25 %predicted), respectively, with 29% and 3% participants not achieving their predicted normal range. Oxygen saturation at peak exercise was 98%±1% and remained >93% in all participants. Sixty-six per cent showed hypertensive response to exercise. In models adjusted for covariates, WattsPeak was associated directly with O2-PulsePeak, HRPeak and SBPPeak and inversely with SHS, air trapping (residual volume/total lung capacity) and rise of SBP over workload (all p<0.01). Moreover, SHS exposure association with WattsPeak was substantially (41%) mediated through its effect on O2-PulsePeak (p=0.038). Although not statistically significant, a considerable proportion (36%) of air trapping effect on WattsPeak seemed to be mediated through O2-PulsePeak (p=0.078). The likelihood of having baseline respiratory symptoms (modified Medical Research Council score ≥1) was associated with steeper rise in SBP over workload (p<0.01). CONCLUSION In a never-smoker population with remote exposure to SHS, abnormal escalation of blood pressure and an SHS-associated reduction in cardiac output contributed to lower exercise capacity.
Collapse
Affiliation(s)
- Siyang Zeng
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
- Pulmonary and Critical Care Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Michelle Dunn
- Pulmonary and Critical Care Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
| | - Warren M Gold
- Department of Medicine, University of California, San Francisco, California, USA
| | - Jorge R Kizer
- Department of Medicine, University of California, San Francisco, California, USA
- Cardiology Section, San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Mehrdad Arjomandi
- Pulmonary and Critical Care Section, San Francisco Veterans Affairs Health Care System, San Francisco, California, USA
- Department of Medicine, University of California, San Francisco, California, USA
| |
Collapse
|
7
|
Schultz MG, Currie KD, Hedman K, Climie RE, Maiorana A, Coombes JS, Sharman JE. The Identification and Management of High Blood Pressure Using Exercise Blood Pressure: Current Evidence and Practical Guidance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052819. [PMID: 35270514 PMCID: PMC8910717 DOI: 10.3390/ijerph19052819] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 02/16/2022] [Accepted: 02/24/2022] [Indexed: 11/16/2022]
Abstract
High blood pressure (BP) is a leading risk factor for cardiovascular disease (CVD). The identification of high BP is conventionally based on in-clinic (resting) BP measures, performed within primary health care settings. However, many cases of high BP go unrecognised or remain inadequately controlled. Thus, there is a need for complementary settings and methods for BP assessment to identify and control high BP more effectively. Exaggerated exercise BP is associated with increased CVD risk and may be a medium to improve identification and control of high BP because it is suggestive of high BP gone undetected on the basis of standard in-clinic BP measures at rest. This paper provides the evidence to support a pathway to aid identification and control of high BP in clinical exercise settings via the measurement of exercise BP. It is recommended that exercise professionals conducting exercise testing should measure BP at a fixed submaximal exercise workload at moderate intensity (e.g., ~70% age-predicted heart rate maximum, stage 1-2 of a standard Bruce treadmill protocol). If exercise systolic BP is raised (≥170 mmHg), uncontrolled high BP should be assumed and should trigger correspondence with a primary care physician to encourage follow-up care to ascertain true BP control (i.e., home, or ambulatory BP) alongside a hypertension-guided exercise and lifestyle intervention to lower CVD risk related to high BP.
Collapse
Affiliation(s)
- Martin G. Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia; (R.E.C.); (J.E.S.)
- Correspondence: ; Tel.: +61-(0)-3-6226-4264; Fax: +61-(0)-3-6226-7704
| | - Katharine D. Currie
- Department of Kinesiology, Michigan State University, East Lansing, MI 48824, USA;
| | - Kristofer Hedman
- Department of Clinical Physiology in Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, 58183 Linköping, Sweden;
| | - Rachel E. Climie
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia; (R.E.C.); (J.E.S.)
| | - Andrew Maiorana
- Faculty of Health Sciences, School of Physiotherapy and Exercise Science, Curtin University and Allied Health Department, Fiona Stanley Hospital, Perth, WA 6102, Australia;
| | - Jeff S. Coombes
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD 4072, Australia;
| | - James E. Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS 7000, Australia; (R.E.C.); (J.E.S.)
| |
Collapse
|
8
|
Blood pressure response during treadmill exercise testing and the risk for future cardiovascular events and new-onset hypertension. J Hypertens 2022; 40:143-152. [PMID: 34857707 DOI: 10.1097/hjh.0000000000002991] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The physiologic response to exercise may provide valuable prognostic information. We investigated the association of blood pressure (BP) measurements during exercise stress testing (EST) with long-term risk of myocardial infarction, stroke or death (major adverse cardiovascular event, MACE), as well as the development of new-onset hypertension. METHODS A retrospective analysis of treadmill ESTs (years 2005-2019) performed by the Bruce protocol in patients aged 35-75 years without a history of cardiovascular disease (n = 14 792; 48% women). BP was documented at rest, submaximal exercise (Bruce stage-2), peak exercise and recovery (2 min). Association of SBP measures with study outcomes during median follow-up of 6.5 years was investigated. RESULTS Highest vs. lowest SBP quartile at rest (≥140 vs. <120 mmHg), submaximal-exercise (≥170 vs. <130 mmHg), peak-exercise (≥180 vs. ≤145 mmHg) and recovery (≥160 vs. <130 mmHg) was associated with an increase in the adjusted hazard ratio and 95% confidence interval (CI) for MACE: 1.53 (1.23-1.88), 1.33 (1.01-1.76), 1.30 (1.05-1.61), 1.35 (1.09-1.68), respectively. The association between SBP at submaximal exercise and recovery with MACE displayed a J-shaped pattern. Among nonhypertensive patients (n = 8529), excessive SBP response to peak exercise (≥190 mmHg in women and ≥210 mmHg in men) was an independent predictor of hypertension [hazard ratio (95% CI)]: 1.87 (1.41-2.48), as were SBPs during submaximal exercise [>160 vs. ≤130 mmHg: 2.44 (1.97-3.03)] and recovery [≥140 vs. ≤120 mmHg: 1.65 (1.37-1.98)]. CONCLUSION BP measurement during rest, exercise and recovery phases of EST provides incremental prognostic information regarding long-term risk for cardiovascular events and the probability for developing hypertension.
Collapse
|
9
|
Schultz MG, La Gerche A, Sharman JE. Cardiorespiratory Fitness, Workload, and the Blood Pressure Response to Exercise Testing. Exerc Sport Sci Rev 2021; 50:25-30. [PMID: 34669623 DOI: 10.1249/jes.0000000000000276] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT We propose that for correct clinical interpretation of exaggerated exercise blood pressure (EEBP), both cardiorespiratory fitness and exercise workload must be considered. A key recommendation towards achieving the correct clinical interpretation of EEBP is that exercise BP should be measured during submaximal exercise with a fixed external workload.
Collapse
Affiliation(s)
- Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia Baker Institute, Melbourne, Australia
| | | | | |
Collapse
|
10
|
Kim YJ, Lee SE, Park KM. Exercise characteristics and incidence of abnormal electrocardiogram response in long-distance runners with exercise-induced hypertension. J Clin Hypertens (Greenwich) 2021; 23:1915-1921. [PMID: 34459094 PMCID: PMC8678840 DOI: 10.1111/jch.14359] [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: 05/24/2021] [Revised: 08/17/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
While long‐distance running has important health benefits, chronic elevation of blood pressure during exercise might induce cardiac events and sudden death. This study aimed to investigate characteristics of exercise and incidence of abnormal exercise electrocardiography findings in long‐distance runners with exercise‐induced hypertension. Long‐distance runners (n = 606) underwent a questionnaire survey, history taking, and exercise stress testing, and they were classified into the non‐exercise‐induced (n = 268) and exercise‐induced (n = 338) hypertension groups. Exercise‐induced hypertension was defined as systolic blood pressure ≥210 mm Hg during maximal exercise. Abnormal electrocardiogram response (AER) were defined as abnormal electrocardiography findings, such as arrhythmias or ST‐segment changes, during exercise stress testing. There were no differences in general and exercise‐related characteristics between the non‐exercise‐induced and exercise‐induced hypertension groups. The AER group (AERg, n = 37) had a significantly longer training history and total exercise time than the non‐AER group (non‐AERg, n = 569) (p < .05). Atrial arrhythmias and ST‐segment depression were more prevalent in the exercise‐induced hypertension group than in the non‐exercise‐induced hypertension group (atrial arrhythmias: 5% [17/338] vs. 1.9% [5/268]; ST‐segment depression: 2.7% [9/338] vs. .4% [1/268]; p < .05). The incidence of AER was significantly higher in the exercise‐induced hypertension group (n = 30, 8.8%) than in the non‐exercise‐induced hypertension group (n = 7, 2.6%) (p < .05). This study showed that long‐distance runners with AER had a longer training history and total exercise time than those without AER, and the exercise‐induced hypertension group had a higher rate of AER.
Collapse
Affiliation(s)
- Young-Joo Kim
- Department of Exercise Rehabilitation Welfare, Soojung Campus, Sungshin Women's University, Seoul, Republic of Korea
| | - So-Eun Lee
- College of Wesley Creative Convergence, Hyupsung University, Gyeonggi-do, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
11
|
Acampa W, Rozza F, Zampella E, Assante R, Mannarino T, Nappi C, Mainolfi C, Petretta M, Trimarco B, Cuocolo A. Warranty period of normal stress myocardial perfusion imaging in hypertensive patients: A parametric survival analysis. J Nucl Cardiol 2020; 27:534-541. [PMID: 29679222 DOI: 10.1007/s12350-018-1285-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 04/11/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND We evaluated the warranty period of a normal stress myocardial perfusion single-photon emission computed tomography (MPS) in hypertensive patients. METHODS AND RESULTS A total of 471 consecutive hypertensive patients with suspected coronary artery disease and normal perfusion at stress MPS were followed for a mean of 76 ± 21 months. Endpoint events were cardiac death or nonfatal myocardial infarction. With Cox analysis, age (hazard ratio 1.1, P < .005) and stress test type (hazard ratio 2.7, P < .005) were independent predictors of events. With parametric Weibull analysis, patients ≤60 years old undergoing exercise stress test remained at low risk for the entire length of follow-up, while the highest probability of events and the major risk acceleration were observed in those > 60 years old who underwent pharmacologic stress test. In patients undergoing exercise test, peak systolic blood pressure (BP; hazard ratio 1.1, P < .005) emerged as predictor of events, and only subjects with peak systolic BP < 160 mmHg remained at low risk for the entire length of follow-up. In contrast, for patients with peak systolic BP ≥180 mmHg, the time to achieve a cumulative cardiac risk level of 3% was 18 months. CONCLUSIONS In hypertensive patients, the warranty period of a normal stress MPS varies according to stress type and peak systolic BP. A normal stress MPS can be considered reassuring in subjects ≤60 years old who performed exercise stress test and a peak systolic BP < 160 mmHg.
Collapse
Affiliation(s)
- Wanda Acampa
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
- Institute of Biostructure and Bioimaging, National Council of Research, Naples, Italy
| | - Francesco Rozza
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Ciro Mainolfi
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Mario Petretta
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, University Federico II, Via Pansini 5, 80131, Naples, Italy.
| |
Collapse
|
12
|
The Cardiovascular Stress Response as Early Life Marker of Cardiovascular Health: Applications in Population-Based Pediatric Studies-A Narrative Review. Pediatr Cardiol 2020; 41:1739-1755. [PMID: 32879997 PMCID: PMC7695663 DOI: 10.1007/s00246-020-02436-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/07/2020] [Indexed: 02/06/2023]
Abstract
Stress inducement by physical exercise requires major cardiovascular adaptations in both adults and children to maintain an adequate perfusion of the body. As physical exercise causes a stress situation for the cardiovascular system, cardiovascular exercise stress tests are widely used in clinical practice to reveal subtle cardiovascular pathology in adult and childhood populations with cardiac and cardiovascular diseases. Recently, evidence from small studies suggests that the cardiovascular stress response can also be used within research settings to provide novel insights on subtle differences in cardiovascular health in non-diseased adults and children, as even among healthy populations an abnormal response to physical exercise is associated with an increased risk of cardiovascular diseases. This narrative review is specifically focused on the possibilities of using the cardiovascular stress response to exercise combined with advanced imaging techniques in pediatric population-based studies focused on the early origins of cardiovascular diseases. We discuss the physiology of the cardiovascular stress response to exercise, the type of physical exercise used to induce the cardiovascular stress response in combination with advanced imaging techniques, the obtained measurements with advanced imaging techniques during the cardiovascular exercise stress test and their associations with cardiovascular health outcomes. Finally, we discuss the potential for cardiovascular exercise stress tests to use in pediatric population-based studies focused on the early origins of cardiovascular diseases.
Collapse
|
13
|
Saeed S, Mancia G, Rajani R, Seifert R, Parkin D, Chambers JB. Exercise Treadmill Testing in Moderate or Severe Aortic Stenosis: The Left Ventricular Correlates of an Exaggerated Blood Pressure Rise. J Am Heart Assoc 2019; 7:e010735. [PMID: 30571488 PMCID: PMC6404449 DOI: 10.1161/jaha.118.010735] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Exaggerated blood pressure response during exercise predicts future hypertension and cardiovascular events in general population and different patients groups. However, its clinical and prognostic implications in patients with aortic stenosis have not been previously evaluated. Methods and Results We retrospectively studied 301 patients with moderate to severe asymptomatic aortic stenosis (aged 65±12 years) who underwent echocardiography and a modified Bruce exercise treadmill test. An exaggerated blood pressure response was defined as peak systolic blood pressure ≥190 mm Hg. An abnormal blood pressure response (either blunted or exaggerated) was found in 58% of patients and abnormal left ventricular geometry in 82%. There was no difference in the rates of abnormal blood pressure responses between patients with moderate and severe aortic stenosis ([exaggerated blood pressure response: 21% versus 22%, P=0.876] and [blunted blood pressure response: 35% versus 40%, P=0.647]). Patients with exaggerated blood pressure response (21%) were more likely to be older, have hypertension, higher pretest systolic blood pressure, left ventricular ejection fraction and mass, and increased arterial stiffness (all P<0.05). In a multivariate logistic regression analysis, an exaggerated blood pressure response was associated with higher pulse pressure/stroke volume index (odds ratio 2.45, 95% confidence interval 1.02–6.00, P=0.037) and left ventricular mass (odds ratio 2.04, 95% confidence interval 1.23–3.38, P=0.012) independent of age, hypertension, aortic annulus and left atrium diameter, and left ventricular ejection fraction. Conclusions In those with aortic stenosis, exaggerated blood pressure was strongly related to higher resting blood pressure values, left ventricular mass, and increased arterial stiffness independent of hypertension.
Collapse
Affiliation(s)
- Sahrai Saeed
- 1 Cardiothoracic Centre Guy's & St Thomas' Hospital London United Kingdom.,2 Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Giuseppe Mancia
- 3 University of Milano-Bicocca Milano Italy.,4 Policlinico di Monza Italy
| | - Ronak Rajani
- 1 Cardiothoracic Centre Guy's & St Thomas' Hospital London United Kingdom
| | - Reinhard Seifert
- 2 Department of Heart Disease Haukeland University Hospital Bergen Norway
| | - Denise Parkin
- 1 Cardiothoracic Centre Guy's & St Thomas' Hospital London United Kingdom
| | - John B Chambers
- 1 Cardiothoracic Centre Guy's & St Thomas' Hospital London United Kingdom
| |
Collapse
|
14
|
Mariampillai JE, Liestøl K, Kjeldsen SE, Prestgaard EE, Engeseth K, Bodegard J, Berge E, Gjesdal K, Erikssen J, Grundvold I, Skretteberg PT. Exercise Systolic Blood Pressure at Moderate Workload Is Linearly Associated With Coronary Disease Risk in Healthy Men. Hypertension 2019; 75:44-50. [PMID: 31735088 DOI: 10.1161/hypertensionaha.119.13528] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
There is no consensus on the definition of an exaggerated increase in systolic blood pressure (SBP) during exercise. The aim was to explore a potential threshold for exercise SBP associated with increased risk of coronary heart disease in healthy men using repeated exercise testing. Two thousand fourteen healthy white male employees were recruited into the Oslo Ischemia Study during early 1970s. At follow-up 7 years later, 1392 men were still considered healthy. A bicycle exercise test at 100 W workload was performed at both visits. Cox regression analyses were performed with increasing cutoff levels of peak exercise SBP at 100 W workload (SBP100W) from 160 mm Hg to 200 mm Hg, adjusted for cardiovascular risk factors and physical fitness. Participants with SBP100W below cutoff level at both baseline and first follow-up were compared with participants with SBP100W equal to or above cutoff level at both visits. Compared with participants with SBP100W below all cutoff levels between 165 and 195 mm Hg, coronary heart disease risk was increased among participants with SBP100W equal to or above cutoff at all levels. There was no evidence of a distinct threshold level for coronary heart disease risk, and the relation between SBP100W and coronary heart disease appears linear. When investigating exercise SBP at moderate workload measured at 2 exercise tests in healthy middle-aged white men, there is increasing risk of coronary heart disease with increasing exercise SBP independent of SBP at rest. The association is linear from the low range of exercise SBP, and there is no sign of a distinct threshold level for increased coronary disease risk.
Collapse
Affiliation(s)
- Julian E Mariampillai
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.)
| | - Knut Liestøl
- Institute of Informatics (K.L.), University of Oslo, Norway
| | - Sverre E Kjeldsen
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.).,Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Erik E Prestgaard
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.).,Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Kristian Engeseth
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.).,Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Johan Bodegard
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.)
| | - Eivind Berge
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.).,Institute of Clinical Medicine; University of Tromsø, Norway (E.B.)
| | - Knut Gjesdal
- Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Jan Erikssen
- Institute of Clinical Medicine (S.E.K., E.E.P., K.E., K.G., J.E.), University of Oslo, Norway
| | - Irene Grundvold
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.)
| | - Per T Skretteberg
- From the Department of Cardiology, Oslo University Hospital, Ullevaal, Norway (J.E.M., S.E.K., E.E.P., K.E., J.B., E.B., I.G., P.T.S.)
| |
Collapse
|
15
|
Schultz MG, Park C, Fraser A, Howe LD, Jones S, Rapala A, Davey Smith G, Sharman JE, Lawlor DA, Chaturvedi N, Deanfield J, Hughes AD. Submaximal exercise blood pressure and cardiovascular structure in adolescence. Int J Cardiol 2019; 275:152-157. [PMID: 30509371 PMCID: PMC6282652 DOI: 10.1016/j.ijcard.2018.10.060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 10/11/2018] [Accepted: 10/17/2018] [Indexed: 12/20/2022]
Abstract
PURPOSE Dynamic exercise results in increased systolic blood pressure (BP). Irrespective of resting BP, some individuals may experience exaggerated rise in systolic BP with exercise, which in adulthood is associated with risk of hypertension, and cardiovascular (CV) disease. It is unknown if exercise BP is associated with markers of CV structure during adolescence. We examined this question in a large adolescent cohort taking account of the possible confounding effect of body composition and BP status. METHODS 4036 adolescents (mean age 17.8 ± 0.4 years, 45% male), part of a UK population-based birth cohort study completed a sub-maximal step-test with BP immediately post-exercise. Sub-samples underwent comprehensive echocardiography for assessment of cardiac structure; arterial structure including aortic pulse wave velocity (PWV) and carotid intima-media thickness; and assessment of body composition by dual-energy X-ray absorptiometry (DXA). RESULTS Each 5 mm Hg higher post-exercise systolic BP was associated with CV structure, including 0.38 g/m2.7 (95% CI: 0.29, 0.47) greater left-ventricular mass index (LVMI), and 0.04 m/s (95% CI: 0.03, 0.04) greater aortic PWV. Adjustment for age, total body fat, lean mass and BP status attenuated, but did not abolish associations with LVMI (0.14 g/m2.7 per 5 mm Hg of post-exercise systolic BP; 95% CI 0.21, 0.39) or aortic PWV (0.03 m/s per 5 mm Hg of post-exercise systolic BP; 95% CI: 0.02, 0.04). CONCLUSION Submaximal exercise systolic BP is associated with markers of CV structure in adolescents. Given the clinical relevance of exercise BP in adulthood, such associations may have implications for CV disease screening in young people and risk in later life.
Collapse
Affiliation(s)
- Martin G Schultz
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
| | - Chloe Park
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Abigail Fraser
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, UK
| | - Laura D Howe
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Siana Jones
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Alicja Rapala
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - James E Sharman
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Deborah A Lawlor
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; School of Social and Community Medicine, University of Bristol, Bristol, UK; NIHR Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and the University of Bristol, UK
| | - Nish Chaturvedi
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - John Deanfield
- Institute of Cardiovascular Sciences, University College London, London, UK
| | - Alun D Hughes
- Institute of Cardiovascular Sciences, University College London, London, UK
| |
Collapse
|
16
|
Ali SI, Li Y, Adam M, Xie M. Evaluation of Left Ventricular Systolic Function and Mass in Primary Hypertensive Patients by Echocardiography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:39-49. [PMID: 30027675 DOI: 10.1002/jum.14687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Revised: 04/05/2018] [Accepted: 04/06/2018] [Indexed: 06/08/2023]
Abstract
Hypertension is an independent risk factor for cardiovascular diseases. The accurate evaluation of cardiovascular risk is of paramount importance in the management of hypertensive patients. Conventional echocardiographic methods have provided the assessment of left ventricular systolic function and mass for many years. Tissue Doppler imaging, 3-dimensional echocardiography, and speckle tracking echocardiography are newer echocardiographic modalities for the left ventricular systolic function and mass quantification. The major emphasis of this review is to evaluate the left ventricular systolic function and mass by conventional and newly developed echocardiographic in hypertensive patients.
Collapse
Affiliation(s)
- Shima Ibrahim Ali
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
- Faculty of Radiological Sciences and Medical Imaging, Alzaiem Alazhari University, Khartoum North, Sudan
| | - Yuman Li
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| | - Mohamed Adam
- Colleges of Applied Medical Science, Radiology Department, King Khalid University, Kingdom of Saudi Arabia
| | - Mingxing Xie
- Department of Ultrasound, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China
| |
Collapse
|
17
|
Wernhart S, Halle M. Echocardiographic E/A inversion and air trapping at rest are associated with an exaggerated blood pressure response in medically controlled hypertensives during bicycle ergometry. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1707014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Simon Wernhart
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Cardiology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Munich Heart Alliance, Munich, Germany
| |
Collapse
|
18
|
Orabona R, Sciatti E, Vizzardi E, Bonadei I, Prefumo F, Valcamonico A, Metra M, Frusca T. Ultrasound evaluation of left ventricular and aortic fibrosis after pre-eclampsia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:648-653. [PMID: 28782135 DOI: 10.1002/uog.18825] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 06/27/2017] [Accepted: 07/28/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Myocardial fibrosis is associated with adverse clinical outcome in adults. Our aim was to investigate using echocardiographic calibrated integrated backscatter (cIBS) the presence of myocardial and/or aortic fibrosis in asymptomatic women with a history of early-onset (EO) or late-onset (LO) pre-eclampsia (PE). METHODS Thirty non-pregnant women whose most recent pregnancy was complicated by EO-PE, 30 with previous LO-PE pregnancy and 30 controls who had experienced only uncomplicated pregnancy previously were selected retrospectively from our electronic database and recalled between 6 months and 4 years after delivery. Data regarding gestational age (GA) and mean uterine artery (UtA) pulsatility index (PI) at diagnosis of PE were collected from their medical records. The women underwent cardiovascular assessment, during which the presence of fibrosis was investigated, by means of cIBS, at the basal interventricular septum (cIBSIVS ), the basal posterior wall (cIBSPW ) and the anterior wall of the ascending aorta, 3 cm above the valve (cIBSAO ). These findings were compared between the three patient groups. RESULTS Using cIBS imaging, we found significant left ventricular (LV) fibrosis in women with a history of EO-PE compared with those with previous LO-PE pregnancy and controls (intergroup ANOVA P < 0.001 for cIBSIVS and P = 0.005 for cIBSPW ), whereas aortic fibrosis did not differ significantly among cases and controls. Stepwise multivariate regression analysis showed that LV fibrosis was associated independently with lower GA and higher mean UtA-PI at diagnosis of PE, while cIBSAO correlated with aortic diameters, stiffness and ventricular-arterial coupling. CONCLUSIONS Women with a history of EO-PE show LV fibrosis in the short-medium term after delivery compared with women with previous LO-PE pregnancy and controls. LV fibrosis is associated with GA and mean UtA-PI at onset of PE. Larger studies using cardiac magnetic resonance imaging are needed to validate and confirm our findings. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- R Orabona
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - E Sciatti
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - E Vizzardi
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - I Bonadei
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - F Prefumo
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - A Valcamonico
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
| | - M Metra
- Section of Cardiovascular Diseases, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - T Frusca
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Brescia, Italy
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| |
Collapse
|
19
|
Kieu A, Shaikh A, Kaeppler M, Miles RJ, Widlansky ME. Patients with hypertensive responses to exercise or dobutamine stress testing differ in resting hypertensive phenotype. ACTA ACUST UNITED AC 2017; 12:108-116. [PMID: 29275921 DOI: 10.1016/j.jash.2017.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/10/2017] [Accepted: 12/10/2017] [Indexed: 10/18/2022]
Abstract
Little is known of the importance of echocardiographic measures of resting systemic vascular resistance (SVR), cardiac output, and diastolic function in the development of a hypertensive response during dobutamine stress echocardiography. We performed a retrospective review of 325 subjects who underwent stress echocardiography and a resting echocardiogram on the same day. Logistical regressions were performed to determine associations between hypertensive response to each type of stress test and clinical and hemodynamic measurements obtained by transthoracic echocardiography. Patients with a hypertensive response to dobutamine or exercise stress modalities had Stage 1 hypertension. Those with a hypertensive response to dobutamine had a significantly elevated SVR and a lower cardiac output compared to those with a hypertensive response to exercise or a nonhypertensive response to dobutamine. An SVR ≥2000 dynes × sec/cm5 showed excellent discrimination between patients who did and did not have a hypertensive response to dobutamine (c = 0.80). A hypertensive response to both stress modalities showed an association with measures of diastolic dysfunction. The hemodynamic and echocardiographic phenotypes of individuals with a hypertensive response to exercise differ from those with a hypertensive response to dobutamine. Further work is necessary to understand and guide antihypertensive therapy when a hypertensive response to stress testing is discovered and to inform choice of stress modality when resting hypertension is present.
Collapse
Affiliation(s)
- Andrew Kieu
- Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Armaan Shaikh
- Division of Cardiovascular Medicine, Aurora Healthcare, Milwaukee, WI, USA
| | - Mark Kaeppler
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Robert J Miles
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Michael E Widlansky
- Division of Cardiovascular Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
| |
Collapse
|
20
|
Chung H, Kim JY, Lee BK, Min PK, Yoon YW, Hong BK, Rim SJ, Kwon HM, Choi EY. Arterial stiffness, sex, and age difference on hypertensive response to supine bicycle exercise. J Clin Hypertens (Greenwich) 2017; 19:1260-1268. [PMID: 29067771 DOI: 10.1111/jch.13106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/15/2017] [Accepted: 07/23/2017] [Indexed: 01/01/2023]
Abstract
Contributors to a hypertensive response to exercise (HTR) according to sex and age have not been fully evaluated. The authors analyzed a database of supine bicycle exercise stress echocardiography findings. HTR was defined as peak systolic blood pressure ≥210 mmHg for men and ≥190 mmHg for women during exercise. A total of 797 patients (306 [38%] women) were analyzed, with a mean age of 64 ± 10 years. Female sex, hypertension; higher left ventricular ejection fraction, effective arterial elastance, and pulse wave velocity; and lower total arterial compliance were significantly related to HTR. Patients with HTR had higher relative wall thickness, ratio of early diastolic mitral inflow and annular velocity, and diastolic elastance (all P ≤ .05). In multivariable analysis, indices of arterial stiffness such as pulse wave velocity, arterial elastance, total arterial compliance, and systemic vascular resistance were more strongly related in women, while in men, index of sympathetic activation was additionally related to HTR (all P ≤ .05). Female sex and lower total arterial compliance in older patients (≥65 years) and higher systemic vascular resistance and left ventricular relative wall thickness in younger patients were more strongly related to HTR. In conclusion, HTR was related to arterial stiffness, sympathetic activation, and diastolic dysfunction; however, the associations were different according to sex and age, which might guide individualized therapy.
Collapse
Affiliation(s)
- Hyemoon Chung
- Division of Cardiology, Kyung Hee University School of Medicine, Seoul, Korea.,Division of Medicine, Yonsei University Graduate School, Seoul, Korea
| | - Jong-Youn Kim
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Byoung Kwon Lee
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Pil-Ki Min
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Young Won Yoon
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Bum-Kee Hong
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Joong Rim
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuck Moon Kwon
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eui-Young Choi
- Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
21
|
Schultz MG, La Gerche A, Sharman JE. Blood Pressure Response to Exercise and Cardiovascular Disease. Curr Hypertens Rep 2017; 19:89. [DOI: 10.1007/s11906-017-0787-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|
22
|
Master Sankar Raj V, Patel DR, Ramachandran L. Chronic kidney disease and sports participation by children and adolescents. Transl Pediatr 2017; 6:207-214. [PMID: 28795012 PMCID: PMC5532201 DOI: 10.21037/tp.2017.06.03] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 05/17/2017] [Indexed: 11/06/2022] Open
Abstract
Individuals suffering from chronic kidney disease (CKD) deal with major morbidity and mortality including poor exercise tolerance. A variety of factors including anemia, poor muscle mass, cardiovascular changes and limited physical activity contribute to exercise intolerance. Studies suggest that early initiation of aerobic and resistance training improves the muscle function, ability to tolerate exercise and quality of life in CKD patients. A thorough medical examination and exercise testing are recommended before initiating an exercise regimen in individuals with CKD. Though current recommendations suggest a qualified approval to contact sports in patients with solitary kidney, a proper risk assessment and counselling must be provided detailing all the risks involved. Special care must be taken to avoid infection or damage to the peritoneal dialysis catheter and hemodialysis vascular access sites. Collision sports should be avoided in individuals with kidney transplant, ectopic kidney or with other urological abnormalities (severe hydronephrosis or ureteropelvic junction obstruction) with high risk of injury.
Collapse
Affiliation(s)
- Vimal Master Sankar Raj
- Children’s Hospital of Illinois, University of Illinois College of Medicine at Peoria, Peoria, IL, USA
| | - Dilip R. Patel
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| | - Lakshmi Ramachandran
- Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, MI 49008, USA
| |
Collapse
|
23
|
Mariampillai JE, Engeseth K, Kjeldsen SE, Grundvold I, Liestøl K, Erikssen G, Erikssen J, Bodegard J, Skretteberg PT. Exercise systolic blood pressure at moderate workload predicts cardiovascular disease and mortality through 35 years of follow-up in healthy, middle-aged men. Blood Press 2017; 26:229-236. [DOI: 10.1080/08037051.2017.1291276] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
| | - Kristian Engeseth
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Sverre E. Kjeldsen
- Faculty of Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Irene Grundvold
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
- The Center for Clinical Heart Research, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Knut Liestøl
- Department of Informatics, University of Oslo, Oslo, Norway
| | - Gunnar Erikssen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jan Erikssen
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Johan Bodegard
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | | |
Collapse
|
24
|
Two-dimensional speckle-tracking echocardiography-based left atrial strain parameters predict masked hypertension in patients with hypertensive response to exercise. Blood Press Monit 2017; 22:27-33. [DOI: 10.1097/mbp.0000000000000226] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
25
|
Schultz MG. The clinical importance of exercise blood pressure. Artery Res 2017. [DOI: 10.1016/j.artres.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
26
|
Exaggerated blood pressure response to early stages of exercise stress testing and presence of hypertension. J Sci Med Sport 2016; 19:1039-1042. [DOI: 10.1016/j.jsams.2016.04.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/23/2016] [Accepted: 04/12/2016] [Indexed: 12/22/2022]
|
27
|
Hypertensive response to exercise: mechanisms and clinical implication. Clin Hypertens 2016; 22:17. [PMID: 27468357 PMCID: PMC4962449 DOI: 10.1186/s40885-016-0052-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 07/20/2016] [Indexed: 11/24/2022] Open
Abstract
A hypertensive response to exercise (HRE) is frequently observed in individuals without hypertension or other cardiovascular disease. However, mechanisms and clinical implication of HRE is not fully elucidated. Endothelial dysfunction and increased stiffness of large artery contribute to development of HRE. From neurohormonal aspects, excess stimulation of sympathetic nervous system and augmented rise of angiotensin II seems to be important mechanism in HRE. Increasing evidences indicates that a HRE is associated with functional and structural abnormalities of left ventricle, especially when accompanied by increased central blood pressure. A HRE harbors prognostic significance in future development of hypertension and increased cardiovascular events, particularly if a HRE is documented in moderate intensity of exercise. As supported by previous studies, a HRE is not a benign phenomenon, however, currently, whether to treat a HRE is controversial with uncertain treatment strategy. Considering underlying mechanisms, angiotensin receptor blockers and beta blockers can be suggested in individuals with HRE, however, evidences for efficacy and outcomes of treatment of HRE in individuals without hypertension is scarce and therefore warrants further studies.
Collapse
|
28
|
Mizuno R, Fujimoto S, Saito Y, Yamazaki M. Clinical importance of detecting exaggerated blood pressure response to exercise on antihypertensive therapy. Heart 2016; 102:849-54. [DOI: 10.1136/heartjnl-2015-308805] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 01/11/2016] [Indexed: 02/02/2023] Open
|
29
|
Impact of central haemodynamics on left ventricular function in individuals with an exaggerated blood pressure response to exercise. J Hypertens 2015; 33:612-20; discussion 620. [DOI: 10.1097/hjh.0000000000000431] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
30
|
Nikolic SB, Adams MJ, Otahal P, Edwards LM, Sharman JE. Association of von Willebrand factor blood levels with exercise hypertension. Eur J Appl Physiol 2014; 115:1057-65. [PMID: 25539599 DOI: 10.1007/s00421-014-3087-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 12/16/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE A hypertensive response to moderate intensity exercise (HRE) is associated with increased cardiovascular risk. The mechanisms of an HRE are unclear, although previous studies suggest this may be due to haemostatic and/or haemodynamic factors. We investigated the relationships between an HRE with haemostatic and hemodynamic indices. METHODS Sixty-four participants (57 ± 10 years, 71 % male) with indication for exercise stress testing underwent cardiovascular assessment at rest and during moderate intensity exercise, from which 20 participants developed an HRE (defined as moderate exercise systolic BP ≥ 170 mmHg/men and ≥ 160 mmHg/women). Rest, exercise and post-exercise blood samples were analysed for haemostatic markers, including von Willebrand factor (vWf), and haemodynamic measures of brachial and central blood pressure (BP), aortic stiffness and systemic vascular resistance index (SVRi). RESULTS HRE participants had higher rest vWf compared with normotensive response to exercise (NRE) participants (1,927 mU/mL, 95 % CI 1,240-2,615, vs. 1,129 mU/mL, 95 % CI 871-1,386; p = 0.016). vWf levels significantly decreased from rest to post-exercise in HRE participants (p = 0.005), whereas vWf levels significantly increased from rest to exercise in NRE participants (p = 0.030). HRE participants also had increased triglycerides, rest BP, aortic stiffness and exercise SVRi (p < 0.05 for all). Rest vWf predicted exercise brachial systolic BP (β = 0.220, p = 0.043; adjusted R (2) = 0.451, p < 0.001) independent of age, sex, body mass index, triglycerides, rest brachial systolic BP and aortic stiffness. CONCLUSIONS Increased rest blood levels of vWf are independently associated with moderate intensity exercise systolic BP. These findings implicate abnormalities in haemostasis as a possible factor contributing to HRE at moderate intensity.
Collapse
Affiliation(s)
- Sonja B Nikolic
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, 7000, Australia
| | | | | | | | | |
Collapse
|
31
|
Abstract
Irrespective of apparent 'normal' resting blood pressure (BP), some individuals may experience an excessive elevation in BP with exercise (i.e. systolic BP ≥210 mm Hg in men or ≥190 mm Hg in women or diastolic BP ≥110 mm Hg in men or women), a condition termed exercise hypertension or a 'hypertensive response to exercise' (HRE). An HRE is a relatively common condition that is identified during standard exercise stress testing; however, due to a lack of information with respect to the clinical ramifications of an HRE, little value is usually placed on such a finding. In this review, we discuss both the clinical importance and underlying physiological contributors of exercise hypertension. Indeed, an HRE is associated with an increased propensity for target organ damage and also predicts the future development of hypertension, cardiovascular events and mortality, independent of resting BP. Moreover, recent work has highlighted that some of the elevated cardiovascular risks associated with an HRE may be related to high-normal resting BP (pre-hypertension) or ambulatory 'masked' hypertension and that an HRE may be an early warning signal of abnormal BP control that is otherwise undetected with clinic BP. Whilst an HRE may be amenable to treatment via pharmacological and lifestyle interventions, the exact physiological mechanism of an HRE remains elusive, but it is likely a manifestation of multiple factors including large artery stiffness, increased peripheral resistance, neural circulatory control and metabolic irregularity. Future research focus may be directed towards determining threshold values to denote the increased risk associated with an HRE and further resolution of the underlying physiological factors involved in the pathogenesis of an HRE.
Collapse
Affiliation(s)
- Martin G Schultz
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tas., Australia
| | - James E Sharman
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tas., Australia
| |
Collapse
|
32
|
Hare JL, Sharman JE, Leano R, Jenkins C, Wright L, Marwick TH. Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise. Am J Hypertens 2013; 26:691-9. [PMID: 23412930 DOI: 10.1093/ajh/hpt008] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Although a hypertensive response to exercise (HRE) is associated with cardiac risk and masked hypertension (MHT), its mechanisms and appropriate treatment remain unclear. We investigated spironolactone as a treatment for abnormal vascular and myocardial stiffness in HRE. METHODS In this randomized, double-blind, placebo-controlled study of 115 patients (54 ± 9 years, 57% men) with an HRE (≥210/105 mm Hg in men; ≥190/105 mm Hg in women) but no prior history of hypertension or myocardial ischemia, MHT prevalence was 40%. Patients were randomized to spironolactone 25mg daily (n = 58) or placebo (n = 57) and underwent evaluation at baseline and 3 months with exercise echocardiography, VO2max, pulse wave velocity (PWV), exercise and central blood pressure (BP), and 24-hour ambulatory BP. Changes in left ventricular mass index (LVMI), Doppler-derived E/em ratio (LV filling pressure), and myocardial strain were assessed. RESULTS Baseline 24-hour systolic BP (SBP) was 133 ± 10 mm Hg and peak-exercise SBP was 219 ± 16 mm Hg. Peak systolic strain (0.3 ± 3.6% vs. -0.1 ± 3.2, P = 0.56), E/em (-1.1 ± 2.3 vs. -0.6 ± 1.7, P = 0.30), VO(2max) (0.4 ± 4.9 vs. -0.9 ± 4.1 ml/kg/min, P = 0.15), and adjusted PWV did not significantly change with treatment, despite reduction in exercise SBP, 24-hour SBP, and LVMI. The change in exercise E/em was of borderline significance (-0.3 ± 2.4 vs. 0.8 ± 2.8, P = 0.06) and became significant after adjustment for baseline differences (P = 0.01). Patients with higher LVMI significantly increased VO(2max) (1.1 ± 5.6 vs. -2.4 ± 4.4 ml/kg/min, P < 0.05) and reduced exercise E/e(m) (-0.7 ± 2.7 vs. 1.9 ± 2.8, P < 0.05). CONCLUSIONS In HRE patients without previous hypertension, short-term spironolactone reduced exercise BP, 24-hour ambulatory BP, LVMI, and E/e(m) but did not significantly alter exercise capacity or myocardial strain.
Collapse
Affiliation(s)
- James L Hare
- School of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | | | | | | |
Collapse
|
33
|
Brunel P, Baschiera F, Cifkova R. Exercise testing in hypertensive patients for assessing the cardiovascular protective potential of antihypertensive drugs. Ther Adv Cardiovasc Dis 2013; 7:99-108. [DOI: 10.1177/1753944713476363] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Exercise testing is an established noninvasive tool in cardiology used to diagnose and guide treatment in individuals with suspected or confirmed coronary artery disease. Owing to the wealth of information it provides, exercise testing is also being utilized to evaluate prehypertensive stages, characterize hypertension, assess tolerance to exercise and the efficacy of antihypertensive therapies, and predict target organ damage and cardiovascular risk. The literature on exercise tolerance tests is relatively limited since these studies are difficult to conduct although they represent a valuable test for evaluating the benefits of antihypertensive therapies beyond their blood-pressure-lowering efficacy at rest or during exercise. Such a setting can be immensely useful for the evaluation and for the differentiation of treatments, especially in patients with evident rises in systolic blood pressure and with concomitant diseases, who are at higher risk of stroke. Exercise-induced increase in systolic blood pressure from rest to peak exercise should therefore be used as the primary efficacy variable. There is growing evidence that central pressure is a better predictor for cardiovascular risk than peripheral blood pressure, since this variable takes into account the overall effect of vascular aging and increased arterial stiffness that age and other concomitant diseases may induce. It is also important to include central aortic blood pressure and biomarkers of hypertension and cardiac disease in the overall assessment.
Collapse
Affiliation(s)
- Patrick Brunel
- Novartis Pharma AG, Fabrikstrasse 4, Postfach CH-4002 Basel Switzerland
| | | | - Renata Cifkova
- Center for Cardiovascular Prevention, Charles University Medical School I and Thomayer Hospital, Prague, Czech Republic
| |
Collapse
|
34
|
Schultz MG, Otahal P, Cleland VJ, Blizzard L, Marwick TH, Sharman JE. Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis. Am J Hypertens 2013; 26:357-66. [PMID: 23382486 DOI: 10.1093/ajh/hps053] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The prognostic relevance of a hypertensive response to exercise (HRE) is ill-defined in individuals undergoing exercise stress testing. The study described here was intended to provide a systematic review and meta-analysis of published literature to determine the value of exercise-related blood pressure (BP) (independent of office BP) for predicting cardiovascular (CV) events and mortality. METHODS Online databases were searched for published longitudinal studies reporting exercise-related BP and CV events and mortality rates. RESULTS We identified for review 12 longitudinal studies with a total of 46,314 individuals without significant coronary artery disease, with total CV event and mortality rates recorded over a mean follow-up of 15.2±4.0 years. After adjustment for age, office BP, and CV risk factors, an HRE at moderate exercise intensity carried a 36% greater rate of CV events and mortality (95% CI, 1.02-1.83, P = 0.039) than that of subjects without an HRE. Additionally, each 10mm Hg increase in systolic BP during exercise at moderate intensity was accompanied by a 4% increase in CV events and mortality, independent of office BP, age, or CV risk factors (95% CI, 1.01-1.07, P = 0.02). Systolic BP at maximal workload was not significantly associated with the outcome of an increased rate of CV, whether analyzed as a categorical (HR=1.49, 95% CI, 0.90-2.46, P = 0.12) or a continuous (HR=1.01, 95% CI, 0.98-1.04, P = 0.53) variable. CONCLUSIONS An HRE at moderate exercise intensity during exercise stress testing is an independent risk factor for CV events and mortality. This highlights the need to determine underlying pathophysiological mechanisms of exercise-induced hypertension.
Collapse
Affiliation(s)
- Martin G Schultz
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | | | | | | | | | | |
Collapse
|
35
|
Kucukler N, Yalçin F, Abraham TP, Garcia MJ. Stress induced hypertensive response: should it be evaluated more carefully? Cardiovasc Ultrasound 2011; 9:22. [PMID: 21846346 PMCID: PMC3167747 DOI: 10.1186/1476-7120-9-22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2011] [Accepted: 08/16/2011] [Indexed: 12/02/2022] Open
Abstract
Various diagnostic methods have been used to evaluate hypertensive patients under physical and pharmacological stress. Several studies have shown that exercise hypertension has an independent, adverse impact on outcome; however, other prognostic studies have shown that exercise hypertension is a favorable prognostic indicator and associated with good outcome. Exercise hypertension may be encountered as a warning signal of hypertension at rest and future hypertensive left ventricular hypertrophy. The results of diagnostic stress tests support that hypertensive response to exercise is frequently associated with high rate-pressure product in hypertensives. In addition to the observations on high rate-pressure product and enhanced ventricular contractility in patients with hypertension, evaluation of myocardial contractility by Doppler tissue imaging has shown hyperdynamic myocardial function under pharmacological stress. These recent quantitative data in hypertensives suggest that hyperdynamic myocardial function and high rate-pressure product response to stress may be related to exaggerated hypertension, which may have more importance than that it has been already given in clinical practice.
Collapse
Affiliation(s)
- Nagehan Kucukler
- Johns Hopkins Medical Institutions, Department of Cardiology, Baltimore, MD, USA
| | - Fatih Yalçin
- Johns Hopkins Medical Institutions, Department of Cardiology, Baltimore, MD, USA
| | - Theodore P Abraham
- Johns Hopkins Medical Institutions, Department of Cardiology, Baltimore, MD, USA
| | - Mario J Garcia
- Montefiore Einstein Center for Heart and Vascular Care, Albert Einstein College of Medicine, New York, NY, USA
| |
Collapse
|
36
|
Galema TW, Yap SC, Soliman OI, Van Thiel RJ, Cate FJT, Brandenburg HJ, Bogers AJ, Simoons ML, Geleijnse ML. Recovery of Long-Axis Left Ventricular Function after Aortic Valve Replacement in Patients with Severe Aortic Stenosis. Echocardiography 2010; 27:1177-81. [DOI: 10.1111/j.1540-8175.2010.01224.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
37
|
Kawasaki T, Yamano M, Kuribayashi T, Kaimoto S, Miki S, Kamitani T, Matsubara H, Sugihara H. Three-layer ultrasonic tissue characterization of the ventricular septum is predictive of prognosis in patients with non-obstructive hypertrophic cardiomyopathy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 12:90-7. [DOI: 10.1093/ejechocard/jeq108] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
38
|
Bertini M, Delgado V, den Uijl DW, Nucifora G, Ng AC, van Bommel RJ, Borleffs CJW, Boriani G, Schalij MJ, Bax JJ. Prediction of Cardiac Resynchronization Therapy Response. Circ Cardiovasc Imaging 2010; 3:86-93. [DOI: 10.1161/circimaging.109.882324] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Left ventricular (LV) fibrosis is important for the response to cardiac resynchronization therapy (CRT). Calibrated integrated backscatter derived by 2D echocardiography quantifies myocardial ultrasound reflectivity, which may provide a surrogate of LV fibrosis. The aim of the study was first, to investigate the relation of myocardial ultrasound reflectivity assessed with calibrated integrated backscatter on CRT response, and second, to explore the “myocardial ultrasound reflectivity–CRT response” relation in patients with ischemic and nonischemic heart failure (HF).
Methods and Results—
One hundred fifty-nine patients with HF referred for CRT underwent an extensive echocardiographic evaluation at baseline and at 6-month follow-up. LV dyssynchrony was derived from speckle-tracking analysis. Calibrated integrated backscatter was obtained from the parasternal long-axis view. The mean value of calibrated integrated backscatter of the anteroseptal and posterior wall was used to estimate myocardial ultrasound reflectivity. CRT response was defined as reduction ≥15% of LV end-systolic volume. At baseline, LV dyssynchrony was significantly larger in responders as compared with nonresponders (188�96 ms versus 115�68 ms,
P
<0.001), and CRT responders showed less myocardial ultrasound reflectivity as compared with nonresponders (−20.8�3.0 dB versus −17.0�3.0 dB,
P
<0.001). In multivariable logistic regression analysis, independent predictors for CRT response were LV dyssynchrony, renal function, and myocardial ultrasound reflectivity. Importantly, myocardial ultrasound reflectivity provided an incremental value to CRT response (χ
2
change=40,
P
<0.001). Considering patients with ischemic HF, the only independent predictor of CRT response was myocardial ultrasound reflectivity, whereas in patients with nonischemic HF, independent predictors of LV reverse remodeling were myocardial ultrasound reflectivity, LV dyssynchrony, and renal function.
Conclusions—
Assessment of myocardial ultrasound reflectivity is important in the prediction of CRT response in ischemic and nonischemic patients.
Collapse
Affiliation(s)
- Matteo Bertini
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Victoria Delgado
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Dennis W. den Uijl
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Gaetano Nucifora
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Arnold C.T. Ng
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Rutger J. van Bommel
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - C. Jan Willem Borleffs
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Giuseppe Boriani
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Martin J. Schalij
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| | - Jeroen J. Bax
- From the Department of Cardiology (M.B., V.D., D.W.d.U., G.N., A.C.T.N., R.J.v.B., C.J.W.B., M.J.S., J.J.B.), Leiden University Medical Center, Leiden, The Netherlands; and the Department of Cardiology (M.B., G.B.), University of Bologna, Bologna, Italy
| |
Collapse
|
39
|
Patel DR, Raj VMS, Torres A. Chronic kidney disease, exercise, and sports in children, adolescents, and adults. PHYSICIAN SPORTSMED 2009; 37:11-9. [PMID: 20048524 DOI: 10.3810/psm.2009.10.1724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Individuals with chronic kidney disease have poor exercise tolerance and are easily fatigued compared with their healthy peers. The primary reasons for poor exercise tolerance include anemia, effects of chronic uremia and metabolic acidosis on the heart and skeletal muscles, and lower levels of physical activity. Studies suggest that regular and early implementation of both aerobic and resistance exercise programs in persons with chronic kidney disease have positive effects on muscle function, exercise tolerance, and quality of life. Before starting any exercise program, a medical assessment and exercise testing are generally recommended. No consensus exists regarding allowing young athletes with a solitary kidney who want to participate in contact or collision sports. Decisions to allow participation in different sports and leisure activities should be made on an individual basis, considering multiple factors. This article reviews factors that affect exercise tolerance in persons with chronic kidney disease, the effects of exercise, and exercise recommendations.
Collapse
Affiliation(s)
- Dilip R Patel
- Michigan State University Kalamazoo, Center for Medical Studies, 1000 Oakland Dr., Kalamazoo, MI 49008, USA.
| | | | | |
Collapse
|
40
|
Triantafyllou KA, Karabinos E, Kalkandi H, Kranidis AI, Babalis D. Clinical implications of the echocardiographic assessment of left ventricular long axis function. Clin Res Cardiol 2009; 98:521-32. [DOI: 10.1007/s00392-009-0046-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 06/29/2009] [Indexed: 10/20/2022]
|
41
|
Gaddam KK, Verma A, Thompson M, Amin R, Ventura H. Hypertension and cardiac failure in its various forms. Med Clin North Am 2009; 93:665-80. [PMID: 19427498 DOI: 10.1016/j.mcna.2009.02.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Hypertension clearly increases the risk of systolic or diastolic heart failure. With aging population and advancements in treatment of cardiovascular diseases, the prevalence of heart failure is ever-increasing and is a principal cause of cardiovascular morbidity and mortality. Treating hypertension has been shown to decrease the risk of development of heart failure and hence underscores the early recognition and treatment of hypertension and hypertensive heart disease. Antihypertensive treatment with drugs from all classes except direct vasodilators is effective in reversing LVH and preventing heart failure. Also, all of the major classes of antihypertensive drugs, particularly beta-blockers and RAS antagonists, with the exception of calcium antagonists, have been shown to improve survival in patients who have LV systolic dysfunction. However, phenotyping and identifying the pathophysiology and appropriate treatments for patients who have diastolic dysfunction and heart failure with preserved ejection fraction has been a daunting task. At this time, treatment of these patients is largely empiric, focusing on BP control, and treating or avoiding intravascular volume overload.
Collapse
Affiliation(s)
- Krishna K Gaddam
- Department of Medicine, Division of Cardiovascular Diseases, Ochsner Clinic Foundation, New Orleans, LA 70121, USA
| | | | | | | | | |
Collapse
|
42
|
Demir H, Tan YZ, Isgoren S, Gorur GD, Kozdag G, Ural E, Berk F. Comparison of exercise and pharmacological stress gated SPECT in detecting transient left ventricular dysfunction. Ann Nucl Med 2008; 22:403-9. [PMID: 18600418 DOI: 10.1007/s12149-008-0119-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2007] [Accepted: 01/16/2008] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Transient left ventricular contractile dysfunction (TLVD) is observed owing to post-exercise stunning in patients with coronary artery disease (CAD). Pharmacological stimulation differs from exercise stress because it does not cause demand ischemia. The aim of this study was to determine whether TLVD could also be seen after pharmacological stress (dipyridamole). METHODS Of the patients in whom gated single-photon emission computed tomography (GSPECT) was performed in our institution from January 2004 to April 2007, 439 subjects with known or suspected CAD were included in the study. GSPECT was performed for all patients following exercise (group I, n = 220) or pharmacological stress (group II, n = 219) according to a 2-day (stress-rest) protocol after injection of Tc-99m methoxyisobutyl-isonitrile (MIBI). Stress, rest, and difference (stress-rest value) left ventricular ejection fractions (SLVEF, RLVEF, and DLVEF) and transient ischemic dilatation (TID) ratio were derived automatically. Summed stress score, summed rest score, and summed difference score (SDS) for myocardial perfusion were calculated using a 20-segment model and a five-point scoring system. An SDS > 3 was considered as ischemic. On the basis of the perfusion findings, patients were subdivided into a normal (group A, n = 216) and ischemia group (group B, n = 223). DLVEF and perfusion scores of all groups were compared. Relationships between DLVEF and perfusion, and between TID ratio and DLVEF were also evaluated. RESULTS Stress-induced ischemia was observed in 223 of 439 patients (50.8%). In group A, the difference between stress and rest LVEF values was not significant (P = 0.670 and P = 0.200 for groups IA and IIA, respectively). However, LVEF was significantly decreased after stress compared with rest values for group B (P < 0.0001 for groups IB and IIB). TLVD (< or =-5% for DLVEF) was observed in 20 of 216 (9%) and 81 of 223 subjects (36%) in patients in groups A and B, respectively (P < 0.0001). In group I, we found TLVD in 46 of 119 (39%) and 12 of 101 (12%) subjects, in patients with and without ischemia, respectively (P < 0.0001). On the other hand, in group II, TLVD was detected in 35 of 104 (34%) and 8 of 115 (7%) patients with and without ischemia, respectively (P < 0.0001). And also, we found significant good correlations between TID ratios and DLVEF values in four subgroups (r = -0.55, r = -0.62, r = -0.59, and r = -0.41; for groups IA, IB, IIA, and IIB, respectively, P < 0.0001 for all). CONCLUSIONS Dipyridamole is believed to be less likely than exercise to induce ischemia. However, in this study, TLVD after stress was observed following not only exercise but also pharmacological stress, consistent with ischemia.
Collapse
Affiliation(s)
- Hakan Demir
- Department of Nuclear Medicine, Kocaeli University School of Medicine, Umuttepe Yerleskesi, 41380 Kocaeli, Turkey.
| | | | | | | | | | | | | |
Collapse
|
43
|
Left ventricular long-axis dysfunction in hypertensive patients. J Hypertens 2008. [DOI: 10.1097/hjh.0b013e328303e61e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
44
|
Galema TW, Yap SC, Geleijnse ML, van Thiel RJ, Lindemans J, ten Cate FJ, Roos-Hesselink JW, Bogers AJJC, Simoons ML. Early Detection of Left Ventricular Dysfunction by Doppler Tissue Imaging and N-terminal Pro-B-type Natriuretic Peptide in Patients with Symptomatic Severe Aortic Stenosis. J Am Soc Echocardiogr 2008; 21:257-61. [PMID: 17628412 DOI: 10.1016/j.echo.2007.05.030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Patients with severe aortic stenosis (AS) require valve replacement before development of irreversible left ventricular (LV) dysfunction. It has been postulated that Doppler tissue imaging (DTI) parameters are more sensitive to detect subtle LV dysfunction compared with conventional echocardiographic parameters. OBJECTIVE We sought to assess early LV dysfunction with DTI-derived echocardiographic parameters and N-terminal pro-B-type natriuretic peptide (NT-proBNP) in patients with severe AS and normal LV ejection fraction. METHODS A total of 29 patients (mean age 65 +/- 12 years, 15 male) with symptomatic severe AS and 17 control subjects were included in the study. DTI was performed at the level of the mitral lateral (m(lat)) and septal (m(sep)) annulus. Systolic (Sm), early (Em), and late (Am) diastolic velocities were measured, and E/Em ratio was calculated. NT-proBNP was determined by an electrochemiluminescence immunoassay. RESULTS Baseline characteristics between patients and control subjects were similar regarding LV ejection fraction and mitral inflow E/A ratio. However, patients with AS had significantly lower DTI values (Sm, Em, Am) compared with control subjects. Moreover, LV filling pressures, expressed by the E/Em ratio, were significantly higher in patients. Correlation analysis showed a relationship between the natural logarithm of NT-proBNP and aortic valve area, Sm(lat), and E/Em((sep)) ratio. Using stepwise multiple linear regression, Sm(lat) was found to be independently related to NT-proBNP. CONCLUSIONS In patients with severe AS and normal LV ejection fraction, DTI showed LV systolic and diastolic dysfunction compared with control subjects. DTI-derived variables, and especially Sm(lat), were correlated with NT-proBNP levels.
Collapse
Affiliation(s)
- Tjebbe W Galema
- Department of Cardiology, Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
TAKAMURA T, ONISHI K, SUGIMOTO T, KURITA T, FUJIMOTO N, DOHI K, TANIGAWA T, ISAKA N, NOBORI T, ITO M. Patients with a Hypertensive Response to Exercise Have Impaired Left Ventricular Diastolic Function. Hypertens Res 2008; 31:257-63. [DOI: 10.1291/hypres.31.257] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
46
|
Yoneyama A, Koyama J, Tomita T, Kumazaki S, Tsutsui H, Watanabe N, Kinoshita O, Ikeda U. Relationship of plasma brain-type natriuretic peptide levels to left ventricular longitudinal function in patients with congestive heart failure assessed by strain Doppler imaging. Int J Cardiol 2007; 130:56-63. [PMID: 18068244 DOI: 10.1016/j.ijcard.2007.07.171] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2006] [Revised: 05/10/2007] [Accepted: 07/20/2007] [Indexed: 01/08/2023]
Abstract
BACKGROUND Plasma brain-type natriuretic peptide (BNP) levels have been used to diagnose congestive heart failure (CHF), but significant heterogeneity in BNP levels is not explained by standard echocardiographic indexes of cardiac function. Recent data indicate that longitudinal left ventricular (LV) dysfunction exists in the presence of normal standard echocardiographic indexes and BNP was predicted well by LV longitudinal systolic velocity. We examined whether longitudinal LV function assessed by strain or strain rate (SR) tissue Doppler imaging could be determinants of plasma BNP levels in patients with CHF. METHODS We examined 137 consecutive patients with suspected CHF. Standard echocardiography and Doppler flow records were obtained. Strain, and SR at the basal and mid parts of the ventricle were investigated in 2 apical views. Tissue velocities of mitral annulus were also obtained. Plasma BNP levels were measured on the day of echocardiography. RESULTS Multivariate analysis showed the mean longitudinal LV strain (r=0.75, P<0.0001) to be an independent powerful predictor of plasma log BNP levels. Subgroup analysis (ejection fraction <50%, n=30; ejection fraction >50%, n=107) also showed that the mean longitudinal LV strain (r=0.89, P<0.0001; r=0.68, P<0.0001, respectively) was only an independent predictor of log BNP levels. CONCLUSION Longitudinal LV strain is closely related to log BNP levels in patients with CHF, both in patients with systolic and diastolic heart failure.
Collapse
Affiliation(s)
- Ayako Yoneyama
- Department of Cardiovascular Medicine, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | | | | | | | | | | | | | | |
Collapse
|
47
|
Pellikka PA, Nagueh SF, Elhendy AA, Kuehl CA, Sawada SG. American Society of Echocardiography recommendations for performance, interpretation, and application of stress echocardiography. J Am Soc Echocardiogr 2007; 20:1021-41. [PMID: 17765820 DOI: 10.1016/j.echo.2007.07.003] [Citation(s) in RCA: 510] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Patricia A Pellikka
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Foundation, Rochester, Minnesota 55905, USA.
| | | | | | | | | |
Collapse
|
48
|
Kim JS, Cho JR, Park S, Shim J, Kim JB, Cho DK, Shin HJ, Park CM, Ko YG, Ha JW, Choi D, Rim SJ, Jang Y, Chung N. Endothelial nitric oxide synthase Glu298Asp gene polymorphism is associated with hypertensive response to exercise in well-controlled hypertensive patients. Yonsei Med J 2007; 48:389-395. [PMID: 17594145 PMCID: PMC2628106 DOI: 10.3349/ymj.2007.48.3.389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Hypertensive response to exercise (HRE) is known to be an adverse prognostic factor for future cardiovascular events and may be associated to endothelial dysfunction. Previous studies regarding endothelial nitric oxide synthase (eNOS) Glu298Asp polymorphism focused upon its relation to hypertension. In this study, we hypothesize that the polymorphism may be associated with inherent difference in endothelial response to exercise. PATIENTS AND METHODS Two hundred sixty nine patients who underwent treadmill test were enrolled in this study; 77 patients (mean age 55.8 +/- 9.4 years) had hypertensive response (peak systolic BP of > or = 210 mmHg in men and > or = 190 mmHg in women). Pulse wave velocity (PWV) was measured on 153 patients of them. The Glu298Asp exchange in exon 7 was determined by the methods of single base extension with amplifying primers and probes for TaqMan. RESULTS The percentages of the GG, GT and TT genotypes were 81.0, 18.6 and 0.4 %, respectively. The presence of GT or TT genotype was independently associated with prevention of HRE when controlled for age, sex, baseline systolic BP and homeostatic model assessment (HOMA) index (OR=0.35, p=0.016). Subgroup analysis showed that preventive effect for HRE of T allele was significant in females (p < 0.001) and patients without insulin resistance (p=0.009). CONCLUSION In our study, eNOS Glu298Asp polymorphism was significantly associated with HRE. This result suggests that the presence of T allele of the Glu298Asp polymorphism may be a favorable factor to in preventing HRE, especially in female and patients without insulin resistance.
Collapse
Affiliation(s)
- Jung-Sun Kim
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Rae Cho
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Genome Center, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Bae Kim
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Deok-Kyu Cho
- Division of Cardiology, Cardiovascular Center, Gwandong University College of Medicine, Goyang, Korea
| | - Hyun-Joon Shin
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Chan Mi Park
- Cardiovascular Genome Center, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Young-Guk Ko
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jong-Won Ha
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Donghoon Choi
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Joong Rim
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| | - Yangsoo Jang
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Genome Center, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, Korea
| | - Namsik Chung
- Division of Cardiology, Yonsei University College of Medicine, Seoul, Korea
| |
Collapse
|
49
|
Yosefy C, Jafari J, Klainman E, Brodkin B, Handschumacher MD, Vaturi M. The prognostic value of post-exercise blood pressure reduction in patients with hypertensive response during exercise stress test. Int J Cardiol 2006; 111:352-7. [PMID: 16239041 DOI: 10.1016/j.ijcard.2005.07.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2005] [Accepted: 07/24/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Hypertensive response at peak-exercise and during the recovery phase of exercise stress test (ET) is associated with poor cardiovascular prognosis. We investigated whether decrease in blood pressure (BP) from peak to post-exercise would identify a subgroup at higher cardiovascular risk. METHODS Eighty-six non-hypertensive patients (0-4 cardiovascular risk factors) with hypertensive reaction at peak-ET (systolic>180 mm Hg and/or diastolic>100 mm Hg) were divided based on BP 5 min after exercise termination into two groups: Normal response (NrmR) (<160/90 mm Hg), Hypertensive response (HypR) (>/=160/90 mm Hg). Five years later the prevalence of cardiovascular risk factors and cardiovascular morbidity and mortality was assessed for each group. RESULTS Both groups had similar pre- and peak-exercise BP. However the HypR group had higher post-exercise BP (systolic: 163+/-13 vs. 125+/-14 mm Hg, respectively, p<0.01, and diastolic: 74+/-6 vs. 75+/-4 mm Hg, respectively, p<0.01), smaller decrease in BP after exercise (Delta systolic: 46.9+/-3.1 vs. 73.9+/-3.6 mm Hg, respectively, p<0.01, Delta diastolic: 12.4+/-1.5 vs. 26.5+/-2.2 mm Hg, respectively, p<0.01), and higher post- than pre-exercise BP (Delta systolic: 24.5+/-3.5 vs. -6+/-4.1 mm Hg, respectively, p<0.01, A diastolic: 19+/-2.1 vs. -13+/-2.3 mm Hg, respectively, p<0.01). Five years later, HypR group had higher prevalence of abnormal cholesterol serum level (p<0.01), hypertension (p<0.01) and combined ischemic heart disease and cerebrovascular disease (RR 1.32, 95% CI=1.13-1.54, p<0.01). CONCLUSION During ET evaluation, it is important to evaluate the BP at 5 min after exercise because reduced BP drop, at this routinely measured point, identifies a subgroup with higher cardiovascular risk.
Collapse
Affiliation(s)
- Chaim Yosefy
- Cardiac Ultrasound Laboratory, Massachusetts General Hospital, 55 Fruit St., VBK 508, Harvard Medical School, Boston, MA, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Park S, Shim J, Kim JB, Ko YG, Choi D, Ha JW, Rim SJ, Jang Y, Chung N. Insulin resistance is associated with hypertensive response to exercise in non-diabetic hypertensive patients. Diabetes Res Clin Pract 2006; 73:65-9. [PMID: 16413944 DOI: 10.1016/j.diabres.2005.11.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2005] [Accepted: 11/25/2005] [Indexed: 12/27/2022]
Abstract
AIM Insulin resistance is associated with increased sympathetic activity and elevated angiotensin II which may contribute to the excessive increase in arterial blood pressure during exercise. In this study, we hypothesized that increased insulin resistance will be significantly associated with hypertensive response to exercise (HRE) in non-diabetic hypertensive patients. METHOD Two hundred seventy-five hypertensive patients were included in this study. HOMA-IR index using serum fasting glucose and insulin was calculated for insulin resistance. There were 79 patients with hypertensive response (age 56.1+/-9.4 years) and 196 patients without hypertensive response (age 53.9+/-8.9 years). RESULTS Insulin resistance, assessed by HOMA index, was significantly higher in hypertensive response group as compared to control (HOMA=2.60+/-1.54 versus 1.76+/-0.86, P<0.001). HOMA was an independent predictor of HRE when controlled for age, sex, BMI and baseline SBP (odds ratio=2.008, P<0.001). Also, HOMA was significantly correlated with the magnitude of SBP elevation controlled for age, sex, BMI and baseline SBP as well (beta=0.293, P<0.001). In conclusion, this study shows that insulin resistance is a significant determinant of hypertensive response to exercise. Further studies to determine the prognostic significance of this finding is warranted.
Collapse
Affiliation(s)
- Sungha Park
- Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, SeodaemunGu 120-752, Seoul, South Korea
| | | | | | | | | | | | | | | | | |
Collapse
|