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Yang Y, Li Y, Zhu L, Xu J, Tang X, Gao P. Blood pressure control and left ventricular echocardiographic progression in hypertensive patients: an 18-month follow-up study. Front Cardiovasc Med 2023; 10:1161993. [PMID: 37564911 PMCID: PMC10410104 DOI: 10.3389/fcvm.2023.1161993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/11/2023] [Indexed: 08/12/2023] Open
Abstract
Objectives The impact of blood pressure (BP) control and its timing on left ventricular (LV) structure and function remains unclear. The present study was to evaluate whether BP control correlated with conventional LV geometry and function indexes or global longitudinal strain (GLS) progression, and when echocardiographic changes would occur in essential hypertension. Methods and results A total of 62 participants (mean age 55.2 ± 11.5, male 71.0%) with uncontrolled hypertension were enrolled in the longitudinal study. Patients were followed up at the 6-month and 18-month, when echocardiographic measurements were performed and BP control was evaluated during the follow up period. At the 6- and 18-month examination, we divided the hypertensive patients into two groups as BP controlled and uncontrolled group. Patients with BP uncontrolled (n = 33) had higher LV mass index (P = 0.02), higher left atrial volume index (P = 0.01), worse GLS (P = 0.005) and GLS changes (P = 0.003) compared with controlled BP (n = 29) at the 6-month follow-up examination. Patients with uncontrolled BP (n = 25) had higher LV mass index (P = 0.001), higher LV mass index changes (P = 0.01), higher relative wall thickness (P = 0.01), higher E/e' (P = 0.046), worse GLS (P = 0.02) and GLS changes (P = 0.02) compared to BP controlled group (n = 24) at the 18-month follow-up examination. GLS changes were associated with BP control (β = 0.370, P = 0.004 at the 6-month examination and β = 0.324, P = 0.02 at the 18-month examination, respectively) in stepwise multivariate regression analysis. LV mass index changes was corelated with systolic BP (β = 0.426, P = 0.003) at the 18-month follow-up examination in stepwise multivariate regression analysis. Neither was GLS changes nor LV mass index changes were related to antihypertensive medication class, including combination therapy in 6- or 18-month follow up examination. Conclusions Our findings offer new clinical evidence on the association of BP control with echocardiographic changes in hypertensive patients, and, in particular, support the view that GLS progression was earlier and subtler than conventional LV geometry and function parameters. GLS changes were significant between BP controlled and uncontrolled patients even in 6-month follow-up period.
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Affiliation(s)
- Yan Yang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Li
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Limin Zhu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianzhong Xu
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaofeng Tang
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Pingjin Gao
- Department of Cardiovascular Medicine, State Key Laboratory of Medical Genomics, Shanghai Key Laboratory of Hypertension, Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Laboratory of Vascular Biology, Institute of Health Sciences, Shanghai Institutes for Biological Sciences, Chinese Academy of Sciences, Shanghai, China
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Jorge JA, Foppa M, Santos ABS, Cichelero FT, Martinez D, Lucca MB, de Oliveira GPF, Fuchs FD, Fuchs SC. Effects of Antihypertensive Treatment on Left and Right Ventricular Global Longitudinal Strain and Diastolic Parameters in Patients with Hypertension and Obstructive Sleep Apnea: Randomized Clinical Trial of Chlorthalidone plus Amiloride vs. Amlodipine. J Clin Med 2023; 12:jcm12113785. [PMID: 37297980 DOI: 10.3390/jcm12113785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/19/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
Hypertension is highly prevalent in patients with obstructive sleep apnea (OSA), and fluid retention with its nighttime rostral distribution is one potential mechanism. We tested whether or not diuretics differ from amlodipine in their impact on echocardiographic parameters. Patients with moderate OSA and hypertension were randomized to receive diuretics (chlorthalidone plus amiloride) or amlodipine daily for 8 weeks. We compared their effects on left and right ventricular global longitudinal strain (LV-GLS and RV-GLS, respectively), on LV diastolic parameters, and on LV remodeling. In the 55 participants who had echocardiographic images feasible for strain analysis, all echocardiographic parameters were within normal ranges. After 8 weeks, the 24 h blood pressure (BP) reduction values were similar, while most echocardiographic metrics were kept unchanged, except for LV-GLS and LV mass. In conclusion, the use of diuretics or amlodipine had small and similar effects on echocardiographic parameters in patients with moderate OSA and hypertension, suggesting that they do not have important effects on mediating the interaction between OSA and hypertension.
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Affiliation(s)
- Juliano A Jorge
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Murilo Foppa
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Angela B S Santos
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Fábio T Cichelero
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Denis Martinez
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Marcelo B Lucca
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Geórgia P F de Oliveira
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
| | - Flávio D Fuchs
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- Division of Cardiology, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre 90035-903, RS, Brazil
| | - Sandra C Fuchs
- Graduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
- INCT PREVER, Hospital de Clínicas de Porto Alegre (HCPA), School of Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre 90035-903, RS, Brazil
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Bertacchini F, Agabiti Rosei C, Buso G, Cappellini S, Stassaldi D, Aggiusti C, Salvetti M, Paini A, De Ciuceis C, Muiesan ML. Subclinical HMOD in Hypertension: Left Ventricular Diastolic Dysfunction. High Blood Press Cardiovasc Prev 2022; 29:585-593. [PMID: 36352335 PMCID: PMC9708770 DOI: 10.1007/s40292-022-00548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023] Open
Abstract
Arterial hypertension represents an important risk factor for the development of cardiac, vascular and renal events, predisposing to heart failure, acute coronary syndromes, peripheral artery disease, stroke, and chronic renal disease. Arterial hypertension leads to the development of subclinical hypertension mediated organ damage (HMOD) which has prognostic relevance and may influence the choice of treatment options. Alterations of cardiac structure and function represent the more widely assessed form of HMOD. This manuscript will focus on the diagnostic opportunities, prognostic significance and treatment of diastolic dysfunction alterations.
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Affiliation(s)
- Fabio Bertacchini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Claudia Agabiti Rosei
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Sara Cappellini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Deborah Stassaldi
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carlo Aggiusti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Anna Paini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carolina De Ciuceis
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy.
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Karev E, Verbilo SL, Malev EG, Prokudina MN. The impact of medical therapy on left ventricular strain: Current state and future perspectives. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:887-898. [PMID: 35617148 DOI: 10.1002/jcu.23244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 04/21/2022] [Accepted: 05/16/2022] [Indexed: 06/15/2023]
Abstract
The speckle tracking strain is becoming a frequently used marker of subclinical left ventricular systolic dysfunction. Despite the wide range of data concerning left ventricular strain variability in the general population and its changes in various pathologic conditions, the information about the impact of medical therapy on left ventricle strain is limited. This article provides an analysis of published studies of left ventricle strain changes in response to different agents and combinations of medical therapies used for hypertension and congestive heart failure.
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Affiliation(s)
- Egor Karev
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Center" of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Sergey L Verbilo
- Federal State Budgetary Institution "V.A. Almazov National Medical Research Center" of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Eduard G Malev
- Research Laboratory for Connective Tissue Dysplasia, Heart and Vessels Institute, Federal State Budgetary Institution "V.A. Almazov National Medical Research Center" of the Ministry of Health of the Russian Federation, Saint Petersburg, Russia
| | - Maria N Prokudina
- Limited Liability Company "International Heart Center", 6 Tverskaya street, Saint-Petersburg, 191015, Russia
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5
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Pugliese NR, Balletti A, Armenia S, De Biase N, Faita F, Mengozzi A, Paneni F, Ruschitzka F, Virdis A, Ghiadoni L, Taddei S, Williams B, Antonini-Canterin F, Masi S. Ventricular-Arterial Coupling Derived From Proximal Aortic Stiffness and Aerobic Capacity Across the Heart Failure Spectrum. JACC Cardiovasc Imaging 2022; 15:1545-1559. [DOI: 10.1016/j.jcmg.2022.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 02/28/2022] [Accepted: 03/25/2022] [Indexed: 12/27/2022]
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Abstract
AIM Evidence on the impact of blood pressure (BP)-lowering drugs on left ventricular (LV) mechanics in hypertension is still limited. We performed a meta-analysis of speckle-tracking echocardiographic studies in order to provide a new piece of information on this topic. METHODS The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search for articles published from the inception up to 31 October 2021. Studies were identified by using MeSH terms and crossing the following search items: 'myocardial strain', 'left ventricular mechanics', 'speckle tracking echocardiography', 'systolic dysfunction', 'left ventricular hypertrophy', 'systemic hypertension', 'BP lowering drugs,' 'antihypertensive therapy'. RESULTS A total of 1140 hypertensive patients (mean age 55.4 years, 50% men, follow-up 6-36 months) were included in eight studies. Pretreatment and posttreatment pooled SBP/DBPs were 148.4 ± 3.5/88.7 ± 2 vs. 127.4 ± 1.9/77.8 ± 0.9 mmHg. Corresponding values for ejection fraction (EF), LV mass (LVM) index, and global longitudinal strain (GLS) were 64 ± 2.3 vs. 65.9 ± 1.7% (SMD: 0.14 ± 0.03, CI 0.08- 0.20, P = 0.001); 108.4 ± 11.2 vs. 100.2 ± 11.0 g/m2 (SMD: -0.27 ± 0.10, CI -0.46 to -0.08, P < 0.01); -17.7 ± 0.6 vs. -19.6 ± 0.4%, (SMD 0.26 ± 0.03, CI 0.20-0.32, P < 0.0001), respectively. A meta-regression analysis showed a significant relation between GLS improvement and the extent of reduction of LVMI (P = 0.0003), but not of SBP (P = 0.27). CONCLUSION Our meta-analysis suggests that antihypertensive treatment has a clear beneficial effect on LV mechanisms, and the improvement in GLS is mainly related to the reduction in LVMI rather than SBP.
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7
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Subclinical cardiac dysfunction in pediatric kidney transplant recipients identified by speckle-tracking echocardiography. Pediatr Nephrol 2022; 37:2489-2501. [PMID: 35166914 PMCID: PMC9395460 DOI: 10.1007/s00467-022-05422-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 12/25/2021] [Accepted: 12/27/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Kidney transplantation (KTx) improves prognosis in children with kidney failure; still, these patients are prone to cardiovascular damage due to multiple risk factors. Our aim was to assess myocardial structure and function in pediatric KTx by conventional and speckle-tracking echocardiography (STE) in association with established cardiovascular risk factors. METHODS Forty-two KTx and 39 healthy age- and gender-matched children were evaluated. KTx recipients were further categorized according to the control of hypertension assessed by 24-h ambulatory blood pressure monitoring (ABPM). Subjects underwent pulse wave velocity (PWV) measurement, conventional echocardiography, and 2-dimensional STE. Left and right ventricular (LV, RV) global longitudinal strain (GLS), and LV circumferential strain (GCS) were measured. Glomerular filtration rate (eGFR) was calculated according to the Schwartz formula. RESULTS KTx patients had increased blood pressure and arterial stiffness. LV ejection fraction (EF) was preserved along with elevated LV mass index (LVMi) while LVGLS was significantly lower, whereas LVGCS and RVGLS were increased in KTx. Uncontrolled hypertensives had lower LVGLS compared to those with controlled hypertension. Using multiple forward stepwise regression analysis, 24-h SBP and relative wall thickness (RWT) were independent determinants of LVMi, whereas antihypertensive therapy, eGFR, and HOMA-IR were independent determinants of LVGLS. CONCLUSIONS Cardiac morphology and function show distinct changes after KTx. Along with comparable ventricular volumes, LV hypertrophy and subclinical myocardial dysfunction are present. Control of hypertension and kidney graft function are major factors of LV performance. STE may be useful to reveal early myocardial dysfunction in pediatric KTx. A higher resolution version of the Graphical abstract is available as Supplementary information.
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Jordan AN, Fulford J, Gooding K, Anning C, Wilkes L, Ball C, Pamphilon N, Mawson D, Clark CE, Shore AC, Sharp ASP, Bellenger NG. Morphological and functional cardiac consequences of rapid hypertension treatment: a cohort study. J Cardiovasc Magn Reson 2021; 23:122. [PMID: 34689818 PMCID: PMC8543888 DOI: 10.1186/s12968-021-00805-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 08/12/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Left ventricular (LV) hypertrophy (LVH) in uncontrolled hypertension is an independent predictor of mortality, though its regression with treatment improves outcomes. Retrospective data suggest that early control of hypertension provides a prognostic advantage and this strategy is included in the 2018 European guidelines, which recommend treating grade II/III hypertension to target blood pressure (BP) within 3 months. The earliest LVH regression to date was demonstrated by echocardiography at 24 weeks. The effect of a rapid guideline-based treatment protocol on LV remodelling, with very early BP control by 18 weeks remains controversial and previously unreported. We aimed to determine whether such rapid hypertension treatment is associated with improvements in LV structure and function through paired cardiovascular magnetic resonance (CMR) scanning at baseline and 18 weeks, utilising CMR mass and feature tracking analysis. METHODS We recruited participants with never-treated grade II/III hypertension, initiating a guideline-based treatment protocol which aimed to achieve BP control within 18 weeks. CMR and feature tracking were used to assess myocardial morphology and function immediately before and after treatment. RESULTS We acquired complete pre- and 18-week post-treatment data for 41 participants. During the interval, LV mass index reduced significantly (43.5 ± 9.8 to 37.6 ± 8.3 g/m2, p < 0.001) following treatment, accompanied by reductions in LV ejection fraction (65.6 ± 6.8 to 63.4 ± 7.1%, p = 0.03), global radial strain (46.1 ± 9.7 to 39.1 ± 10.9, p < 0.001), mid-circumferential strain (- 20.8 ± 4.9 to - 19.1 ± 3.7, p = 0.02), apical circumferential strain (- 26.0 ± 5.3 to - 23.4 ± 4.2, p = 0.003) and apical rotation (9.8 ± 5.0 to 7.5 ± 4.5, p = 0.003). CONCLUSIONS LVH regresses following just 18 weeks of intensive antihypertensive treatment in subjects with newly-diagnosed grade II/III hypertension. This is accompanied by potentially advantageous functional changes within the myocardium and supports the hypothesis that rapid treatment of hypertension could improve clinical outcomes. TRIAL REGISTRATION ISRCTN registry number: 57475376 (assigned 25/06/2015).
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Affiliation(s)
- Andrew N Jordan
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK.
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK.
- Diabetes and Vascular Research Centre, Royal Devon and Exeter NHS Foundation Trust, Barrack Road, Exeter, EX2 5DW, UK.
| | - Jon Fulford
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Kim Gooding
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Christine Anning
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Lindsay Wilkes
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Claire Ball
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Nicola Pamphilon
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - David Mawson
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
| | - Christopher E Clark
- Primary Care Research Group, Exeter College of Medicine and Health, Smeall Building, St Luke's Campus, Magdalen Road, Exeter, EX1 2LU, UK
| | - Angela C Shore
- Vascular Medicine, NIHR Exeter Clinical Research Facility, Exeter, UK
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
| | - Andrew S P Sharp
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
- Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, UK
| | - Nicholas G Bellenger
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, EX2 5AX, UK
- Department of Cardiology, Royal Devon and Exeter Hospital, Exeter, UK
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Abstract
PURPOSE OF REVIEW Resistant hypertension (RH) is a major contributor to cardiovascular diseases and is associated with increased all-cause and cardiovascular mortality. Cardiac changes such as impaired left ventricular (LV) function, left ventricular hypertrophy (LVH), myocardial fibrosis, and enlarged left atrium (LA) are consequences of chronic exposure to an elevated blood pressure. The purpose of this review article is to demonstrate the potential benefits of using STE as a non-invasive imaging technique in the assessment of cardiac remodeling in patients with hypertension and specifically in uncontrolled and RH population. RECENT FINDINGS It is well-recognized that conventional transthoracic echocardiography is a useful analytic imaging modality to evaluate hypertension-mediated organ damage (HMOD) and in a resistant hypertensive population. More recently two-dimensional speckle tracking echocardiography (STE) has been utilized to provide further risk assessment to this population. Recent data has shown that STE is a new promising echocardiographic marker to evaluate early stage LV dysfunction and myocardial fibrosis over conventional 2D parameters in patients with cardiovascular diseases.
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Tadic M, Cuspidi C. The Effect of Antihypertensive Therapy on Left Ventricular Longitudinal Strain: Missing Part of the Puzzle. J Cardiovasc Transl Res 2020; 14:125-128. [PMID: 32086702 DOI: 10.1007/s12265-020-09970-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 02/11/2020] [Indexed: 10/25/2022]
Abstract
There is no consensus regarding the benefit of antihypertensive therapy on left ventricular structure and function. The most of studies investigated the effect of therapy on left ventricular hypertrophy, less studies were focused on left ventricular diastolic dysfunction and the minority on left ventricular mechanics. The majority of investigations showed positive effect of antihypertensive therapy on regression of left ventricular remodeling. Nevertheless, it is very difficult to distinguish the effect of antihypertensive medication from the effect of blood pressure reduction on left ventricular improvement. The other important issue in these studies is difficulty to distinguish the effect of left ventricular hypertrophy regression from the effect of antihypertensive medications on left ventricular diastolic function and mechanics. The novel findings suggest that the cascade of left ventricular remodeling in hypertensive heart disease begins with mechanical changes, continuous with diastolic dysfunction, and ends with left ventricular hypertrophy. This is very important paradigm because it enables early and timely diagnosis of subclinical left ventricular damage in hypertensive patients and should provide rapid detection of left ventricular function improvement during antihypertensive therapy.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Clinical Hospital Center "Dr. Dragisa Misovic-Dedinje", Heroja Milana Tepica 1, Belgrade, 11000, Serbia.
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Viale della Resistenza 23, 20036, Meda, Italy
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11
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Ikonomidis I, Katsanos S, Triantafyllidi H, Parissis J, Tzortzis S, Pavlidis G, Trivilou P, Makavos G, Varoudi M, Frogoudaki A, Vrettou AR, Vlastos D, Lekakis J, Iliodromitis E. Pulse wave velocity to global longitudinal strain ratio in hypertension. Eur J Clin Invest 2019; 49:e13049. [PMID: 30422317 DOI: 10.1111/eci.13049] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 10/13/2018] [Accepted: 11/08/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Arterial elastance to left ventricular elastance ratio assessed by echocardiography is widely used as a marker of ventricular-arterial coupling. MATERIALS AND METHODS We investigated whether the ratio of carotid-femoral pulse wave velocity, as a marker of arterial stiffness, to global longitudinal strain, as a marker of left ventricular performance, could be better associated with vascular and cardiac damage than the established arterial elastance/left ventricular elastance index. In 299 newly-diagnosed untreated hypertensives we measured, carotid-femoral pulse wave velocity, and carotid intima-media thickness, coronary-flow reserve, arterial elastance/left ventricular elastance, global longitudinal strain, and markers of left ventricular diastolic function (E/A and E') by echocardiography. RESULTS Pulse wave velocity-to-global longitudinal strain ratio (PWV/GLS) was lower in hypertensives than controls (-0.61 ± 0.21 vs -0.45 ± 0.11 m/sec%, P < 0.001). Low PWV/GLS values were associated with carotid-intima media thickness > 0.9 mm (P = 0.003), E/A ≤ 0.8 (P = 0.019) and E' ≤ 9 cm/sec (P = 0.002) and coronary-flow reserve < 2.5 (P = 0.017), after adjustment for age, sex and mean arterial pressure. Low PWV/GLS was also associated with increased left ventricular mass and left atrial volume in the univariate (P = 0.003 and 0.038) but not in the multivariate model. In hypertensives, there was no significant association of arterial elastance-to-left ventricular elastance index with carotid intima media thickness, coronary flow reserve, E/A, E', or left atrial volume with the exception of an inverse association with left ventricular mass (P = 0.027). CONCLUSIONS Pulse wave velocity-to-global longitudinal strain ratio but not the echocardiography-derived arterial elastance-to left ventricular elastance index is related to impaired carotid-intima media thickness, coronary-flow reserve and diastolic function in hypertensives.
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Affiliation(s)
- Ignatios Ikonomidis
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Katsanos
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Hellen Triantafyllidi
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Parissis
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Tzortzis
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - George Pavlidis
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Paraskevi Trivilou
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Georgios Makavos
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria Varoudi
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Alexandra Frogoudaki
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Agathi-Rosa Vrettou
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Dimitrios Vlastos
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - John Lekakis
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathios Iliodromitis
- 2nd Department of Cardiology, Medical School, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Kotini-Shah P, Cuadros S, Huang F, Colla JS. Strain analysis for the identification of hypertensive cardiac end-organ damage in the emergency department. Crit Ultrasound J 2018; 10:29. [PMID: 30450528 PMCID: PMC6240555 DOI: 10.1186/s13089-018-0110-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 10/17/2018] [Indexed: 11/23/2022] Open
Abstract
Hypertensive emergency is a life-threatening state. End-organ damage affecting the heart accounts for up to 52% of hypertensive emergencies commonly encountered in the emergency department. Recent evidence indicates that strain echocardiography with computerized speckle-tracking is more sensitive at identifying hypertension induced changes in the left ventricle (LV) mechanical function than traditional 2-D echocardiography. We present a case demonstrating the use of emergency physician performed point-of-care strain echocardiography to identify and quantify LV mechanical dysfunction during a hypertensive crisis and to monitor improvement over 6 h.
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Affiliation(s)
- Pavitra Kotini-Shah
- Department of Emergency Medicine, University of Illinois at Chicago, 808 S. Wood Street (MC 724), Chicago, IL, 60612, USA.
| | - Susana Cuadros
- University of Illinois at Chicago, College of Medicine, Chicago, USA
| | - Felix Huang
- Department of Emergency Medicine, University of Illinois at Chicago, 808 S. Wood Street (MC 724), Chicago, IL, 60612, USA
| | - Joseph S Colla
- Department of Emergency Medicine, University of Illinois at Chicago, 808 S. Wood Street (MC 724), Chicago, IL, 60612, USA
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13
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Kovács A, Molnár AÁ, Kolossváry M, Szilveszter B, Panajotu A, Lakatos BK, Littvay L, Tárnoki ÁD, Tárnoki DL, Voros S, Jermendy G, Sengupta PP, Merkely B, Maurovich-Horvat P. Genetically determined pattern of left ventricular function in normal and hypertensive hearts. J Clin Hypertens (Greenwich) 2018; 20:949-958. [PMID: 29741807 DOI: 10.1111/jch.13271] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/20/2018] [Accepted: 02/28/2018] [Indexed: 01/08/2023]
Abstract
We sought to assess the inheritance of left ventricular (LV) function using speckle-tracking echocardiography and the impact of hypertension on modifying the genetically determined pattern of contraction in a population of twins. We recruited 92 Caucasian twin pairs, including 74 hypertensive (HTN) siblings. Beyond standard echocardiographic protocol, a speckle-tracking analysis was performed, including global longitudinal strain (GLS). Systolic function, as assessed by ejection fraction, showed moderate heritability (61%); however, GLS showed higher and dominant heritability (75%). Heterogeneity models revealed that there were no differences between the HTN and non-HTN subjects regarding the heritability of GLS. However, the heritability estimates of diastolic function parameters, including early diastolic strain rate, were low. LV systolic biomechanics is highly heritable. GLS shows dominant heritability, despite the presence of early-stage hypertensive heart disease. Early diastolic parameters are rather determined by environmental factors. These findings suggest the presence of a genetic framework that conserves systolic function despite the expression of diastolic dysfunction and may underlie the phenotypic progression towards heart failure with preserved ejection fraction.
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Affiliation(s)
- Attila Kovács
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Andrea Ágnes Molnár
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Szilveszter
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexisz Panajotu
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Bálint Károly Lakatos
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Ádám Domonkos Tárnoki
- Hungarian Twin Registry, Budapest, Hungary.,Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
| | - Dávid László Tárnoki
- Hungarian Twin Registry, Budapest, Hungary.,Department of Radiology and Oncotherapy, Semmelweis University, Budapest, Hungary
| | | | - György Jermendy
- III. Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary
| | | | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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14
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15
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Kim D, Shim CY, Hong GR, Park S, Cho IJ, Chang HJ, Ha JW, Chung N. Impact of Ambulatory Blood Pressure on Early Cardiac and Renal Dysfunction in Hypertensive Patients without Clinically Apparent Target Organ Damage. Yonsei Med J 2018; 59:265-272. [PMID: 29436195 PMCID: PMC5823829 DOI: 10.3349/ymj.2018.59.2.265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 12/18/2017] [Accepted: 01/03/2018] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Impaired left ventricular (LV) global longitudinal strain (GLS) and the presence of microalbuminuria indicate early cardiac and renal dysfunction. We aimed to determine the relationships among 24-h ambulatory blood pressure (BP) variables, LV GLS, and urine albumin creatinine ratio (UACR) in hypertensive patients. MATERIALS AND METHODS A total of 130 hypertensive patients (mean age 53 years; 59 men) underwent 24-h ambulatory BP monitoring, measurements of peripheral and central BPs, and transthoracic echocardiography. Patients with apparent LV systolic dysfunction (LV ejection fraction <50%) or chronic kidney disease were not included. LV GLS was calculated using two-dimensional speckle tracking, and UACR was analyzed from spot urine samples. RESULTS In simple correlation analysis, LV GLS showed the most significant correlation with mean daytime diastolic BP (DBP) (r=0.427, p<0.001) among the various BP variables analyzed. UACR revealed a significant correlation only with night-time mean systolic BP (SBP) (r=0.253, p=0.019). In multiple regression analysis, daytime mean DBP and night-time mean SBP were independent determinants for LV GLS (β=0.35, p=0.028) and log UACR (β=0.49, p=0.007), respectively, after controlling for confounding factors. Daytime mean DBP showed better diagnostic performance for impaired LV GLS than did peripheral or central DBPs, which were not diagnostic. Night-time mean SBP showed satisfactory diagnostic performance for microalbuminuria. CONCLUSION There are different associations for daytime and night-time BP with early cardiac and renal dysfunction. Ambulatory BP monitoring provides more relevant BP parameters than do peripheral or central BPs regarding early cardiac and renal dysfunction in hypertensive patients.
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Affiliation(s)
- Darae Kim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Geu Ru Hong
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sungha Park
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - In Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jong Won Ha
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Namsik Chung
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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16
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Speckle tracking echocardiography and tissue Doppler imaging reveal beneficial effect of pharmacotherapy in hypertensives with asymptomatic left ventricular dysfunction. ACTA ACUST UNITED AC 2017; 11:334-342. [DOI: 10.1016/j.jash.2017.03.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 03/04/2017] [Accepted: 03/29/2017] [Indexed: 12/26/2022]
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17
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Cesari M, Letizia C, Angeli P, Sciomer S, Rosi S, Rossi GP. Cardiac Remodeling in Patients With Primary and Secondary Aldosteronism. Circ Cardiovasc Imaging 2016; 9:CIRCIMAGING.116.004815. [DOI: 10.1161/circimaging.116.004815] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/27/2016] [Indexed: 01/12/2023]
Abstract
Background—
Primary aldosteronism (PA) causes excess left ventricular (LV) hypertrophy and diastolic dysfunction; whether this occurs also in secondary aldosteronism (SA) without hypertension is unknown. We investigated the cardiac modifications in patients with preserved LV ejection fraction who had PA or SA.
Methods and Results—
We measured several Doppler echocardiography–derived variables, including tissue Doppler imaging (TDI) parameters and strain rate analysis, in 262 patients with PA, 117 with SA because of liver cirrhosis, and in 61 control healthy subjects. SA and PA patients showed markedly elevated aldosterone levels (67 versus 39 ng/dL, respectively; normal values <15 ng/dL) but contrasting values of plasma renin activity (15.00 versus 0.56 ng/mL/h;
P
<0.001). Compared with PA, SA patients showed higher heart rate, and lower blood pressure and vascular resistance values. Both PA and SA showed increased LV diameters, LV volumes, stroke volume, stroke work, and septal peak systolic tissue velocity, and had more LV hypertrophy (61% and 39%, respectively) and diastolic dysfunction (35% and 36%, respectively) than healthy subjects. Peak systolic septal strain (20% versus 23%;
P
=<0.001) and midwall fractional shortening (15.9% versus 16.7%;
P
=0.001) were lower in PA than in SA patients.
Conclusions—
Primary and secondary hyperaldosteronism correlate with LV enlargement and high prevalence of LV hypertrophy and diastolic dysfunction; a subclinical systolic dysfunction is evident only in PA. In SA, the high rate of LV hypertrophy, in spite of low peripheral resistances and low-to-normal blood pressure, could be accounted for the high renin and aldosterone values, and the work overload associated with a hyperdynamic circulatory state.
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Affiliation(s)
- Maurizio Cesari
- From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.)
| | - Claudio Letizia
- From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.)
| | - Paolo Angeli
- From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.)
| | - Susanna Sciomer
- From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.)
| | - Silvia Rosi
- From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.)
| | - Gian Paolo Rossi
- From the Department of Internal Medicine and Medical Specialties (C.L.), and Department of Cardiovascular, Respiratory, Nephrology, Anesthetic, and Geriatric Sciences (S.S.), University La Sapienza, Rome, Italy; Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Italy (P.A., S.R.); and Hypertension Clinic, Department of Medicine-DIMED, University of Padova, Italy (M.C., G.P.R.)
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Cramariuc D, Gerdts E. Epidemiology of left ventricular hypertrophy in hypertension: implications for the clinic. Expert Rev Cardiovasc Ther 2016; 14:915-26. [DOI: 10.1080/14779072.2016.1186542] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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