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Bartoloni E, Angeli F, Marcucci E, Perricone C, Cafaro G, Riccini C, Spighi L, Gildoni B, Cavallini C, Verdecchia P, Gerli R. Unattended compared to traditional blood pressure measurement in patients with rheumatoid arthritis: a randomised cross-over study. Ann Med 2021; 53:2050-2059. [PMID: 34751628 PMCID: PMC8583925 DOI: 10.1080/07853890.2021.1999493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 10/25/2021] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Hypertension is characterised by a high prevalence, low awareness and poor control among rheumatoid arthritis (RA) patients. Correct blood pressure (BP) measurement is highly important in these subjects. The "unattended" BP measurement aims to reduce the "white-coat effect," a phenomenon associated with cardiovascular risk. Data on "unattended" BP measurement in RA and its impact on hypertensive organ damage are very limited. METHODS BP was measured in the same patient both traditionally ("attended" BP) and by the "unattended" protocol (3 automated office BP measurements, at 1-min intervals, after 5 min of rest, with patient left alone) by a randomised cross-over design. Patients underwent clinical examination, 12-lead electrocardiography and trans-thoracic echocardiography to evaluate cardiac damage. RESULTS Sixty-two RA patients (mean age 67 ± 9 years, 87% women) were enrolled. Hypertension was diagnosed in 79% and 66% of patients according to ACC/AHA and ESC/ESH criteria, respectively. Concordance correlation coefficients between the two techniques were 0.55 (95%, CI 0.38-0.68) for systolic BP and 0.73 (95%, CI 0.60-0.82) for diastolic BP. "Unattended" (121.7/68.6 mmHg) was lower than "attended" BP (130.5/72.8 mmHg) for systolic and diastolic BP (both p < .0001). Among the two techniques, only "unattended" systolic BP showed a significant association with left ventricular mass (r = 0.11; p = .40 for "attended" BP; r = 0.27; p = .036 for unattended BP; difference between slopes: z = 3.92; p = .0001). CONCLUSIONS In RA patients, "unattended" BP is lower than traditional ("attended") BP and more closely associated with LV mass. In these patients, the "unattended" automated BP measurement is a promising tool which requires further evaluation.KEY MESSAGES"Unattended" automated blood pressure registration, aimed to reduce the "white-coat effect" is lower than "attended" value in rheumatoid arthritis patients."Unattended" blood pressure is more closely associated with left ventricular mass than "attende" registration.
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Affiliation(s)
- Elena Bartoloni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Fabio Angeli
- Department of Medicine and Surgery, University of Insubria and Department of Medicine and Cardiopulmonary Rehabilitation, Maugeri Care and Research Institutes, IRCCS Tradate, Varese, Italy
| | - Elisa Marcucci
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Clara Riccini
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Lorenzo Spighi
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Benedetta Gildoni
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Claudio Cavallini
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
| | - Paolo Verdecchia
- Department of Cardiology, Hospital S. Maria della Misericordia, Perugia, Italy
- Fondazione Umbra Cuore e Ipertensione, Perugia, Italy
| | - Roberto Gerli
- Rheumatology Unit, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
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Noninvasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients. J Hypertens 2017; 35:1727-1741. [DOI: 10.1097/hjh.0000000000001396] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Perrone-Filardi P, Coca A, Galderisi M, Paolillo S, Alpendurada F, de Simone G, Donal E, Kahan T, Mancia G, Redon J, Schmieder R, Williams B, Agabiti-Rosei E, Delgado V, Cosyns B, Lombardi M, Lancellotti P, Muraru D, Kauffmann P, Cardim N, Haugaa K, Hagendorff A. Non-invasive cardiovascular imaging for evaluating subclinical target organ damage in hypertensive patients. Eur Heart J Cardiovasc Imaging 2017; 18:945-960. [DOI: 10.1093/ehjci/jex094] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/26/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Pasquale Perrone-Filardi
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | - Antonio Coca
- Hypertension and Vascular Risk Unit, Department of Internal Medicine, Hospital Clínic (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Maurizio Galderisi
- Section of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via Pansini 5, 80131 Naples, Italy
| | | | - Francisco Alpendurada
- NIHR Cardiovascular BRU, Royal Brompton & Harefield NHS Trust, Imperial College London, London, UK
| | - Giovanni de Simone
- Hypertension Research Center (CIRIAPA), Federico II University of Naples, Naples, Italy
| | - Erwan Donal
- Cardiology & Cic-it 1414, CHU Rennes LTSI, Insert 1099, Université Rennes-1, Rennes, France
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Karolinska Institutet, Danderyd Hospital, SE-182 88 Stockholm, Sweden
| | - Giuseppe Mancia
- IRCCS Istituto Auxologico Italiano e Istituto Clinico Universitario di Verano Brianza, Policlinico di Monza, Italy
| | - Josep Redon
- INCLIVA Research Institute, University of Valencia and CIBERObn Carlos III Institute, Madrid, Spain
| | - Roland Schmieder
- University Hospital, Nephrology and Hypertension, Erlangen, Germany
| | - Bryan Williams
- National Institute for Health Research, University College London Hospitals, Biomedical Research Centre, University College London, London, UK
| | - Enrico Agabiti-Rosei
- Department of Clinical and Experimental Sciences, Clinica Medica, Hypertension and Cardiovascular Risk Research Centre, University of Brescia, Spedali Civili, Brescia
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Ogah OS, Sliwa K, Akinyemi JO, Falase AO, Stewart S. Hypertensive heart failure in Nigerian Africans: insights from the Abeokuta Heart Failure Registry. J Clin Hypertens (Greenwich) 2015; 17:263-72. [PMID: 25688932 PMCID: PMC8031496 DOI: 10.1111/jch.12496] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 11/11/2014] [Accepted: 11/13/2014] [Indexed: 11/30/2022]
Abstract
Data from the Abeokuta Heart Failure Registry were used to determine the clinical characteristics, mode of treatment, and short- and medium-term outcomes of patients with hypertensive heart failure. A total of 320 patients were consecutively studied, comprising 184 men (57.5%) and 136 women (42.5%) aged 58.4±12.4 and 60.6±14.5 years, respectively. Most patients (80%) presented with New York Heart Association functional class III or IV and around one third (35%) had preserved systolic function. Median hospital stay was 9 days (interquartile range 5-21) while intra-hospital mortality was 3.4%. The 30-day, 90-day, and 180-day mortality rates were 0.9% (95% confidence interval, -0.2 to 3.5), 3.5% (95% confidence interval, -1.7 to 7.3), and 11.7% (95% confidence interval, -7.8 to 17.5), respectively. In a multiple logistic regression analysis, only serum creatinine was an independent predictor of mortality at 180 days (adjusted odds ratio, 1.76; 95% confidence interval, -1.17 to 2.64). Hypertension is the most common etiological risk factor for heart failure in Nigeria. Most patients present in the fourth decade of life with severe heart failure and secondary valvular dysfunction and significant in-hospital mortality.
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Affiliation(s)
- Okechukwu S. Ogah
- Division of CardiologyDepartment of MedicineUniversity College HospitalIbadanNigeria
- Soweto Cardiovascular Research UnitFaculty of Health SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
| | - Karen Sliwa
- Soweto Cardiovascular Research UnitFaculty of Health SciencesUniversity of the WitwatersrandParktownJohannesburgSouth Africa
- Department of MedicineFaculty of Health SciencesHatter Institute for Cardiovascular Research in Africa & IIDMMUniversity of Cape TownCape TownSouth Africa
| | - Joshua O. Akinyemi
- Department of Epidemiology and Medical StatisticsCollege of MedicineUniversity of IbadanIbadanNigeria
| | - Ayodele O. Falase
- Division of CardiologyDepartment of MedicineUniversity College HospitalIbadanNigeria
| | - Simon Stewart
- Mary MacKillop Institute for Health Research/NHMRC CRE to Reduce Inequality in Heart DiseaseAustralian Catholic UniversityMelbourneVictoriaAustralia
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Lai YH, Liu CC, Kuo JY, Hung TC, Wu YJ, Yeh HI, Bulwer BE, Hung CL. Independent effects of body fat and inflammatory markers on ventricular geometry, midwall function, and atrial remodeling. Clin Cardiol 2014; 37:172-7. [PMID: 24399410 DOI: 10.1002/clc.22242] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2013] [Revised: 12/03/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The effect of body fat distribution on left ventricular (LV) mass and geometry has been recently recognized. However, data regarding circulating inflammatory markers in relation to regional visceral fat deposits, which are metabolically active tissues that can impact cardiac structural remodeling, remain sparse. HYPOTHESIS We hypothesized that obesity has adverse effects on cardiac function and structure. METHODS We consecutively studied 1071 asymptomatic subjects (age 49.5 ± 10.5 years, 39.4% female) free from significant valvular disorders, chronic lung disease, or renal disease. Echocardiography-defined cardiac structures and LV geometries including LV mass, mass-to-volume ratio, and fractional shortening were all determined. Body fat composition (Tanita-305 Body-Fat Analyzer; Tanita Corp., Tokyo, Japan) was obtained and calculated. Multivariate regression models from various models were used to represent the independent association between body fat and echo-derived ventricular mass and geometries. RESULTS In multivariable analysis, increasing body fat was significantly related to increase in left atrial (LA) and LV diameter, posterior wall thickness, relative wall thickness (RWT), LV mass, mass-to-volume ratio, and decreased midwall fractional shortening with or without stress correction (all P < 0.001). When LV mass and severity of mitral regurgitation was further added, the independent association between increased body fat composition and larger LA diameter remained significant (β coefficient = 0.37, P < 0.001). Elevated high-sensitivity C-reactive protein (Hs-CRP) level was associated with larger LA diameter, increased RWT, and worsened midwall mechanics in the female gender (all interaction P < 0.05). CONCLUSIONS Accumulated body fat seemed to be related to worse ventricular midwall contractility and atrial remodeling, particularly in the female gender, with high systemic inflammation. These gender and Hs-CRP-specific modification effects may potentiate the pathological mechanisms involved in heart failure with preserved ejection fraction.
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Affiliation(s)
- Yau-Huei Lai
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College and Mackay Medicine Nursing and Management College, Taipei, Taiwan
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In-treatment midwall and endocardial fractional shortening predict cardiovascular outcome in hypertensive patients with preserved baseline systolic ventricular function: the Losartan Intervention For Endpoint reduction study. J Hypertens 2010; 28:1541-6. [DOI: 10.1097/hjh.0b013e328339f943] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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7
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Cuspidi C, Negri F, Giudici V, Sala C, Mancia G. Impaired midwall mechanics and biventricular hypertrophy in essential hypertension. Blood Press 2010; 19:234-9. [DOI: 10.3109/08037051003606413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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8
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Akintunde A, Akinwusi O, Opadijo G. Left ventricular hypertrophy, geometric patterns and clinical correlates among treated hypertensive Nigerians. Pan Afr Med J 2010; 4:8. [PMID: 21119993 PMCID: PMC2984315 DOI: 10.4314/pamj.v4i1.53602] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2009] [Accepted: 03/02/2010] [Indexed: 01/19/2023] Open
Abstract
Background: Left ventricular hypertrophy can be due to various reasons including hypertension. It constitutes an increased cardiovascular risk. Various left ventricular geometric patterns occur in hypertension and may affect the cardiovascular risk profile of hypertensive subjects. Methods: One hundred and eighty eight hypertensive participated in this study. Left ventricular hypertrophy was diagnosed by echocardiography. Relative wall thickness was derived by 2 × PWT/LVIDd. Subjects were arbitrarily categorized according to the duration of hypertension. Statistical analysis was done using SPSS 15.0. Results: The mean age of the study population was 55.95±10.71 years. Subjects who had hypertension for >5 years were more likely to be older and had a lower ejection fraction, larger left ventricular diastolic internal dimension than those with duration of hypertension <5 years. Concentric remodeling was the commonest left ventricular geometric pattern among the hypertensive subjects closely followed by normal left ventricular geometry. Concentric hypertrophy and eccentric hypertrophy were rare among the study population.Left ventricular geometry was associated mainly with left ventricular chamber and wall dimensions. Conclusion: Concentric remodeling is the commonest pattern of left ventricular geometric pattern of the left ventricle among hypertensive subjects. Left ventricular geometry is associated with the chamber and wall dimensions. Eccentric hypertrophy is associated with the lowest left ventricular systolic function and therefore possibly an herald to progressive systolic impairment.
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Affiliation(s)
- Adeseye Akintunde
- Division of Cardiology, Department of Internal Medicine, LAUTECH Teaching Hospital, Osogbo, Osun State, Nigeria
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Weaver DJ, Kimball T, Witt SA, Glascock BJ, Khoury PR, Kartal J, Mitsnefes MM. Subclinical systolic dysfunction in pediatric patients with chronic kidney disease. J Pediatr 2008; 153:565-9. [PMID: 18534216 DOI: 10.1016/j.jpeds.2008.04.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2007] [Revised: 02/15/2008] [Accepted: 04/07/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Midwall shortening (mwSF) is thought to be a more accurate measure of myocardial performance in the presence of left ventricular hypertrophy (LVH). We examined mwSF in pediatric patients with varying degrees of chronic kidney disease (CKD). STUDY DESIGN Fifty-seven children with CKD stages 2 to 4, 25 who were undergoing hemodialysis and 49 who were transplant recipients, were compared with 35 healthy control subjects. Left ventricular (LV) geometry and indices of LV function were assessed echocardiographically. RESULTS There were no significant differences in LV contractility or endocardial shortening fraction between patients and control subjects. Yet, patients undergoing hemodialysis had significantly lower mwSF compared with control subjects (P < .01) and patients with stage 2 to 4 CKD (P < .01). Renal transplant patients had lower mwSF compared with control subjects (P < .01). The prevalence of abnormal mwSF (ie, <16) was significantly higher in patients undergoing hemodialysis (40%) compared with patients who were renal transplant recipeints (12%) and patients with CKD stages 2 to 4 (9%; P = .03). With stepwise regression, mwSF was demonstrated to be predicted by using relative wall thickness (P < .0001), dialysis group (P = .005), and endocardial shortening fraction (P = .001; model R(2) = 0.86). CONCLUSIONS Children undergoing maintenance hemodialysis and children with concentric LVH have subclinical systolic dysfunction, which might be an indicator for the development of more severe cardiac disease.
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Affiliation(s)
- Donald J Weaver
- Division of Nephrology and Hypertension, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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10
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Ma ZY, Li L, Zhong XZ, Tan HW, Wang R, Wang Y, Zhang W, Zhang Y. Cilnidipine Improves Left-Ventricular Midwall Function Independently of Blood Pressure Changes in Chinese Patients With Hypertension. J Cardiovasc Pharmacol 2007; 49:33-8. [PMID: 17261961 DOI: 10.1097/fjc.0b013e31802bfdee] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite normal indices of left-ventricular (LV) chamber function, patients with hypertension are thought to have depressed LV midwall systolic shortening. This study was designed to investigate effects of short-term therapy with cilnidipine on LV midwall fractional shortening (mFS) in Chinese patients with hypertension. Thirty-seven patients with mild to moderate essential hypertension underwent a 2 week placebo run-in period, then received 5-10 mg/day of cilnidipine orally for 8 weeks. At the end of the placebo period and treatment, patients were examined by echocardiogram, measuring and calculating LV ejection fraction (EF), LV endocardial fraction shortening (eFS), and LV mFS. Compared with the normotensive group, the hypertensive group had a significantly higher eFS (P < 0.05) and EF (P < 0.01), both at the end of the placebo period and at 8 weeks; mFS of patients with hypertension was lower at the end of the placebo period (P < 0.05), but at the end of 8 weeks mFS was not different than that of the control group (P = 0.963). After cilnidipine treatment, EF and eFS did not change (P > 0.05); however, absolute mFS and corrected mFS were increased significantly (P < 0.01). Moreover, changes of mFS showed no correlation with changes of blood pressure (P > 0.05). Midwall fractional shortening is more reliable and sensitive than conventional systolic function measures in assessment of systolic function; cilnidipine can improve left-ventricular systolic function (mFS) independently of blood pressure changes in Chinese patients who have hypertension.
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Affiliation(s)
- Zhi-Yong Ma
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Public Health, Department of Cardiology, QiLu Hospital, Shandong University, Jinan, China
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Lavine SJ, Lavine JA. The Effect of Acute Hypertension on Left Ventricular Diastolic Pressures in a Canine Model of Left Ventricular Dysfunction with a Preserved Ejection Fraction and Elevated Left Ventricular Filling Pressures. J Am Soc Echocardiogr 2006; 19:1350-8. [DOI: 10.1016/j.echo.2006.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2006] [Indexed: 11/30/2022]
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Colonna P, Pinto FJ, Sorino M, Bovenzi F, D'Agostino C, de Luca I. The emerging role of echocardiography in the screening of patients at risk of heart failure. Am J Cardiol 2005; 96:42L-51L. [PMID: 16399092 DOI: 10.1016/j.amjcard.2005.09.062] [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] [Indexed: 11/22/2022]
Abstract
A large number of patients without symptoms of heart failure (HF) have asymptomatic left ventricular (LV) dysfunction owing to the compensatory mechanisms acting through the autonomic nervous system and neurohormones. In the setting of screening for prevention, one must identify the subgroup of these patients at high risk for symptomatic HF to establish appropriate therapy. As a first step to identify the subgroup of patients at high risk, clinical screening scores and natriuretic peptide measurements are used. Second, the definite diagnosis of asymptomatic LV dysfunction must be confirmed with echocardiography, occasionally with the help of new technologic developments to establish prompt, appropriate treatment to prevent disease progression. Therefore, the screening role of echocardiography is the early identification of patients with structural cardiopathy who are at risk of developing symptomatic HF and detection of those without LV dysfunction (diabetic and hypertensive) whose condition is prone to advance rapidly to structural cardiopathy or to symptomatic HF.
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Affiliation(s)
- Paolo Colonna
- Department of Cardiology, Policlinico of Bari, Piazza G. Cesare 11, 70124 Bari, Italy.
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13
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Abstract
Left ventricular hypertrophy (LVH) represents not only an adaptation to increased load, but also a risk factor and a marker of risk of cardiovascular diseases. It may be detected early in the development of the disease by electrocardiography or echocardiography. LVH is often associated to abnormalities of systolic and diastolic function, and its presence clearly predisposes not only to cardiac ischemia and to congestive heart failure, but also to a higher incidence of stroke. A large number of clinical and experimental studies have shown that long-term antihypertensive treatment may be associated with regression of LVH. Long-term antihypertensive treatment is associated with a progressive decrease of LV mass. Differences on reduction of LV mass using different classes of antihypertensive drugs for the same decrease of blood pressure are usually mild, although the effect on cardiac structure and tissue composition are probably not the same. In fact, not only the quantity of left ventricular mass, but also its quality (i.e., collagen content, contractile machinery) should be evaluated and improved by treatment. The incidence of cardiovascular events in hypertensive patients is clearly related to the value of LV mass achieved during treatment; in fact, a reduction in LVH by antihypertensive treatment is associated with improvement in outcome and with decrease of the risk of cardiovascular morbidity and mortality, even independently from changes of other risk factors, including blood pressure. In patients with LVH at baseline, the decrease of LV mass is associated with a number of pathophysiological changes such as 1) improved systolic performance at the midwall, 2) possible improvement of diastolic filling, 3) autonomic nervous system changes toward normalization, 4) possible reduction or ventricular arrhythmias and 5) coronary reserve improvement. All these changes might explain an improvement of clinical prognosis in hypertensive patients. Ongoing studies will more precisely assess the quantitative relation between development or regression of LV mass, improvement of systolic and diastolic function and incidence of cardiovascular events. At present time detection, prevention and reversal of LVH represent a major goal in the management of hypertensive patients.
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Ballo P, Mondillo S, Guerrini F, Barbati R, Picchi A, Focardi M. Midwall mechanics in physiologic and hypertensive concentric hypertrophy. J Am Soc Echocardiogr 2004; 17:418-27. [PMID: 15122180 DOI: 10.1016/j.echo.2004.01.011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE We sought to analyze and compare midwall fractional shortening (mFS), and its relations with circumferential end-systolic stress (cESS) and relative wall thickness (RWT), among subjects with physiologic concentric left ventricular (LV) hypertrophy, patients with hypertension and concentric LV hypertrophy, and control subjects. METHODS A total of 51 normotensive athletes and 56 young patients with hypertension and echocardiographic evidence of concentric LV hypertrophy were enrolled. In addition, 49 age- and sex-matched control subjects were recruited. LV cavity size and wall thicknesses, LV mass, RWT, cESS, and mFS were determined by echocardiography. RESULTS The 3 groups were similar in age, sex, height, weight, body surface area, LV diameters, and conventional indices of systolic function. LV thicknesses, RWT, LV mass, and LV mass index were similarly increased in the athletes and in the hypertensive group when compared with the control subjects. A similar depression in mFS was observed in both the athletes (22.4 +/- 2.6%) and hypertensive group (22.5 +/- 3.6%) in comparison with the control group (24.5 +/- 2.5%, P =.0003). The depression in mFS was still significant after taking into account the effect of cESS, but was no more evident after indexation of mFS by RWT or LV mass. At regression analysis, the relation between mFS and cESS showed a steeper negative slope in the patients with hypertension than in the other 2 groups. CONCLUSIONS MFS is similarly depressed in physiologic and hypertensive concentric LV hypertrophy. The depression is abolished by adjustment for RWT or LV mass, suggesting that geometric factors are the major determinants of midwall performance in both types of concentric LV hypertrophy. However, an impaired response to different values of cESS seems to exist only in hypertensive concentric LV hypertrophy, because increasing levels of cESS may be associated with more evident mFS depression in patients with hypertension than in the athletes and control subjects.
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Affiliation(s)
- Piercarlo Ballo
- U.O. Cardiologia, Ospedale S. Andrea, via Veneto 197, 19100 La Spezia, Italy.
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Fesler P, du Cailar G, Ribstein J, Mimran A. Heterogeneity of Cardiorenal Characteristics in Normotensive Subjects. Hypertension 2004; 43:219-23. [PMID: 14718368 DOI: 10.1161/01.hyp.0000109321.76818.14] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Blood pressure is a marker of elevated risk for cardiovascular disease, even within the normotensive range. The present study evaluates cardiorenal modifications observed in normotensive (<140/90 mm Hg) subjects. Using World Health Organization–International Society of Hypertension definitions, 265 normotensive subjects were categorized as having optimal (n=73), normal (n=84), and high-normal (n=108) blood pressure. Renal hemodynamics and function and cardiac morphology were evaluated by isotopic clearance techniques and ultrasonography, respectively. Urinary albumin excretion was measured in 24-hour urine collections. Body mass index and 24-hour urinary sodium (estimate of sodium intake), as well as left ventricular mass index, relative wall thickness, and glomerular filtration rate and filtration fraction, progressively increased in the optimal to high-normal groups. In contrast, effective renal plasma flow remained constant. Albuminuria was similar in all groups. Of interest, the proportion of subjects with concentric pattern of cardiac geometry (relative wall thickness ≥0.44) increased from 7% in optimal to 13% and 20% in normal and high-normal groups, respectively (
P
<0.05). Within this normotensive range of blood pressure, left ventricular mass index and relative wall thickness but not albuminuria were linearly correlated to systolic blood pressure; however, no correlation with diastolic blood pressure was found. In conclusion, changes in cardiac geometry and renal hemodynamics (increase in glomerular filtration rate and filtration fraction, an approximate index of glomerular pressure) that could predispose to cardiovascular morbidity and renal risk are already present in normotensive subjects with blood pressure higher than 120/80 mm Hg.
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Affiliation(s)
- Pierre Fesler
- Department of Internal Medicine, Centre Hospitalier Universitaire Montpellier, France
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Hashimoto I, Li X, Hejmadi Bhat A, Jones M, Zetts AD, Sahn DJ. Myocardial strain rate is a superior method for evaluation of left ventricular subendocardial function compared with tissue Doppler imaging. J Am Coll Cardiol 2003; 42:1574-83. [PMID: 14607441 DOI: 10.1016/j.jacc.2003.05.002] [Citation(s) in RCA: 108] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES This study was performed to evaluate subendocardial function using strain rate imaging (SRI). BACKGROUND The subendocardium and mid-wall of the left ventricle (LV) play important roles in ventricular function. Previous methods used for evaluating this function are either invasive or cumbersome. Strain rate imaging by ultrasound is a newly developed echocardiographic modality based on tissue Doppler imaging (TDI) that allows quantitative assessment of regional myocardial wall motion. METHODS We examined eight sheep using TDI in apical four-chamber views to evaluate the LV free wall. Peak strain rates (SRs) during isovolumic relaxation (IR), isovolumic contraction (IC), and myocardial strain were measured in the endocardial (End), mid-myocardial (Mid), and epicardial (Epi) layers. For four hemodynamic conditions (created after baseline by blood, dobutamine, and metoprolol infusion), we compared differences in SR of End, Mid, and Epi layers to peak positive and negative first derivative of LV pressure (dP/dt). RESULTS Strain rate during IC showed a good correlation with +dP/dt (r = 0.74, p < 0.001) and during IR with -dP/dt (r = 0.67, p = 0.0003). There was a significant difference in SR between the myocardial layers during both IC and IR (End: -3.4 +/- 2.2 s(-1), Mid: -1.8 +/- 1.5 s(-1), Epi: -0.63 +/- 1.0 s(-1), p < 0.0001 during IC; End: 2.2 +/- 1.5 s(-1), Mid: 1.0 +/- 0.8 s(-1), Epi: 0.47 +/- 0.64 s(-1), p < 0.0001 during IR). Also, SRs of the End and Mid layers during IC were significantly altered by different hemodynamic conditions (End at baseline: 1.7 +/- 0.7 s(-1); blood: 2.0 +/- 1.1 s(-1); dobutamine: 3.4 +/- 2.3 s(-1); metoprolol: 1.0 +/- 0.4 s(-1); p < 0.05). Myocardial strain showed differences in each layer (End: -34.3 +/- 12.6%; Mid: -22.6 +/- 12.1%; Epi: -11.4 +/- 7.9%; p < 0.0001) and changed significantly in different hemodynamic conditions (p < 0.0001). CONCLUSIONS Strain and SR appear useful and sensitive for evaluating myocardial function, especially for the subendocardial region.
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Affiliation(s)
- Ikuo Hashimoto
- Clinical Care Center for Congenital Heart Disease, Oregon Health and Sciences University, Portland, Oregon 97239, USA
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Schillaci G, Vaudo G, Pasqualini L, Reboldi G, Porcellati C, Verdecchia P. Left ventricular mass and systolic dysfunction in essential hypertension. J Hum Hypertens 2002; 16:117-22. [PMID: 11850769 DOI: 10.1038/sj.jhh.1001302] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2001] [Revised: 08/28/2001] [Accepted: 09/07/2001] [Indexed: 11/08/2022]
Abstract
A relation between left ventricular (LV) hypertrophy and depressed midwall systolic function has been described in hypertensive subjects. However, a strong confounding factor in this relation is concentric geometry, which is both a powerful determinant of depressed midwall systolic function and a correlate of LV mass in hypertension. To evaluate the independent contribution of LV mass to depressed systolic function, 1827 patients with never-treated essential hypertension (age 48 +/- 12 years, men 58%) underwent M-mode echocardiography under two-dimensional guidance. Relative wall thickness was the strongest determinant of low midwall fractional shortening (r = -0.63, P < 0.0001). The significant inverse relation observed between LV mass and midwall fractional shortening (r = -0.43, P < 0.0001) persisted after taking into account the effect of relative wall thickness (partial r = -0.27, P < 0.0001). Within each sex-specific quintile of relative wall thickness, prevalence of subnormal afterload-corrected midwall systolic function was greater in subjects with, than in subjects without, LV hypertrophy (P < 0.05 for the first, third, fourth and fifth quintile). In a multiple linear regression analysis, both LV mass (P < 0.0001) and relative wall thickness (P < 0.0001) were independent predictors of a reduced midwall fractional shortening. In conclusion, the inverse association between LV mass and midwall systolic function is partly independent from the effect of relative wall thickness. LV hypertrophy is a determinant of subclinical LV dysfunction independently of the concomitant changes in chamber geometry.
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Affiliation(s)
- G Schillaci
- Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Italy.
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