1
|
Huang S, Li Y, Shi K, Wang J, Jiang L, Gao Y, Yan WF, Yang ZG. Impact of Metabolic Syndrome on Left Ventricular Deformation and Myocardial Energetic Efficiency Compared Between Women and Men: An MRI Study. J Magn Reson Imaging 2022; 57:1743-1751. [PMID: 36196628 DOI: 10.1002/jmri.28455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/15/2022] [Accepted: 09/16/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metabolic and hemodynamic alterations in metabolic syndrome (MetS) can cause a reduced myocardial energetic efficiency (MEE). Indexed MEE (MEEi), as a simple estimate of MEE, is emerging as a novel and useful imaging parameter. PURPOSE To investigate the impact of MetS on MEE and systolic myocardial strain and to assess any sex difference. STUDY TYPE Retrospective. POPULATION A total of 161 patients with MetS (female: n = 82, 52.2 ± 11.7 years; male: n = 79, 51.8 ± 10.6 years) and 77 healthy subjects (female: n = 46, 52.7 ± 8.2 years; male: n = 31, 54.1 ± 11.2 years). Patients with left ventricular (LV) ejection fraction <50% were excluded. FIELD STRENGTH/SEQUENCE A 3.0 T; balanced steady-state free precession sequence. ASSESSMENT LV volumes and mass (LVM) and global longitudinal strain (GLS) were obtained by MRI. Stroke volume (SV) divided by HR was used as a surrogate measure of MEE and normalized to LVM (MEEi). STATISTICAL TESTS Student's t-test or Mann-Whitney U-test; Multivariable linear regression (coefficient of determination, R2 ). P < 0.05 was considered statistically significant. RESULTS For both males and females, MEEi and GLS were lower in MetS patients than in the normal controls. Among MetS patients, men had significantly higher LVM (59.7 ± 13.4 g/m2 vs. 48.8 ± 11.3 g/m2 ) and significantly lower MEEi (0.68 ± 0.23 mL/g/s vs. 0.84 ± 0.23 mL/g/s) and GLS (-11.7% ± 2.8% vs. -13.9% ± 2.7%) than women. After adjustment for clinical variables, male gender (β = -0.291) was found to be inversely correlated with MEEi. Multivariable analysis showed that MEEi (β = 0.454) were independently associated with GLS (adjusted R2 = 0.454) after adjustment for clinical and other MRI parameters. DATA CONCLUSION MEEi was significantly impaired in MetS without overt systolic dysfunction. There was a sex difference regarding the cardiac alterations in MetS, with men having significantly lower MEEi and GLS and significantly higher LVM than women. Further, MEEi was independently associated with GLS. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
Collapse
Affiliation(s)
- Shan Huang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jin Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
2
|
Lembo M, Trimarco V, Manzi MV, Mancusi C, Esposito G, Esposito S, Morisco C, Izzo R, Trimarco B. Determinants of improvement of left ventricular mechano-energetic efficiency in hypertensive patients. Front Cardiovasc Med 2022; 9:977657. [PMID: 35966525 PMCID: PMC9365966 DOI: 10.3389/fcvm.2022.977657] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 07/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Arterial hypertension, especially when coexisting with other cardiovascular risk factors, could determine an imbalance between myocardial energetic demand and altered efficiency, leading to an early left ventricular (LV) systolic dysfunction, even in terms of echo-derived mechano-energetic efficiency indexed for myocardial mass (MEEi). We aim to analyse an improvement in LV MEEi, if any, in a population of hypertensive patients with a long-term follow-up and to identify clinical, metabolic and therapeutic determinants of LV MEEi amelioration. Materials and methods In total, 7,052 hypertensive patients, followed-up for 5.3 ± 4.5 years, enrolled in the Campania Salute Network, underwent echocardiographic and clinical evaluation. LV MEEi was obtained as the ratio between stroke volume and heart rate and normalized per grams of LV mass and ΔMEEi was calculated as difference between follow-up and baseline MEEi. Patients in the highest ΔMEEi quartile (≥0.0454 mL/s/g) (group 1) were compared to the merged first, second and third quartiles (<0.0454 mL/s/g) (group 2). METS-IR (Metabolic Score for Insulin Resistance), an established index of insulin sensitivity, was also derived. Results Patients with MEEi improvement experienced a lower rate of major cardiovascular events (p = 0.02). After excluding patients experiencing cardiovascular events, patients in group 1 were younger (p < 0.0001), less often diabetic (p = 0.001) and obese (p = 0.035). Group 1 experienced more frequently LV mass index reduction, lower occurrence of LV ejection fraction reduction, and had a better metabolic control in terms of mean METS-IR during the follow-up (all p < 0.0001). Beta-blockers were more often used in group 1 (p < 0.0001) than group 2. A logistic regression analysis showed that younger age, lower mean METS-IR values, more frequent LV mass index reduction and therapy with beta-blockers were significantly associated with LV MEEi improvement, independently of presence of diabetes and obesity. Conclusion Metabolic control and therapy with beta-blockers could act in a synergic way, determining an improvement in LV MEEi in hypertensive patients over time, possibly confining cardiac damage and hampering progression toward heart failure.
Collapse
Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Valentina Trimarco
- Department of Neurosciences, Federico II University of Naples, Naples, Italy
| | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Salvatore Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
- *Correspondence: Raffaele Izzo,
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| |
Collapse
|
3
|
Ferrara F, Capone V, Cademartiri F, Vriz O, Cocchia R, Ranieri B, Franzese M, Castaldo R, D’Andrea A, Citro R, Chianese S, Annunziata R, Marullo F, Siniscalchi M, Conte M, Sepe C, Maramaldi R, Rega S, Russo G, Majolo M, Raiola E, Salzano A, Mauro C, Trimarco B, Izzo R, Bossone E. Physiologic Range of Myocardial Mechano-Energetic Efficiency among Healthy Subjects: Impact of Gender and Age. J Pers Med 2022; 12:jpm12060996. [PMID: 35743780 PMCID: PMC9224845 DOI: 10.3390/jpm12060996] [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: 05/23/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Myocardial mechano-energetic efficiency (MEE) is the capability of the left ventricle (LV) to convert the chemical energy obtained from the cardiac oxidative metabolism into mechanical work. The aim of present study was to establish normal non-invasive MEE and MEEi reference values. METHODS In total, 1168 healthy subjects underwent physical examinations, clinical assessment, and standardized transthoracic echocardiographic (TTE) examination. MEE was obtained by TTE as the ratio between stroke volume (SV) and heart rate (HR): MEE = SV/HR [HR expressed in seconds (HR/60)]. Because MEE is highly related to left ventricular mass (LVM), MEE was then divided by LVM with the purpose of obtaining an estimate of energetic expenditure per unit of myocardial mass (i.e., indexed MEE, MEEi, mL/s/g). RESULTS The mean values of MEE and MEEi in the overall population were 61.09 ± 18.19 mL/s; 0.45 ± 0.14, respectively. In a multivariable analysis, gender, body surface area (BSA), diastolic blood pressure, left atrial volume indexed to BSA, E/e' and tricuspid annular plane systolic excursion (TAPSE) were the independent variables associated with MEE, while age, gender, BSA and TAPSE were the independent variables associated with MEEi. CONCLUSIONS The knowledge of age- and gender-based MEE and MEEi normal values may improve the global assessment of LV cardiac mechanics and serve as a reference to identify phenotypes at high risk of cardiovascular events.
Collapse
Affiliation(s)
- Francesco Ferrara
- Heart Department, University Hospital of Salerno, 84131 Salerno, Italy;
| | - Valentina Capone
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (B.T.); (R.I.)
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, 56124 Pisa, Italy;
| | - Olga Vriz
- Echocardiography Department, Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh 11211, Saudi Arabia;
| | - Rosangela Cocchia
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Brigida Ranieri
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113-80143 Naples, Italy; (B.R.); (M.F.); (R.C.); (A.S.)
| | - Monica Franzese
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113-80143 Naples, Italy; (B.R.); (M.F.); (R.C.); (A.S.)
| | - Rossana Castaldo
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113-80143 Naples, Italy; (B.R.); (M.F.); (R.C.); (A.S.)
| | - Antonello D’Andrea
- Department of Cardiology and Intensive Coronary Unit, “Umberto I” Hospital, 84014 Nocera Inferiore, Italy;
| | - Rodolfo Citro
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, 84125 Salerno, Italy;
| | - Salvatore Chianese
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Roberto Annunziata
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Flavio Marullo
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Mario Siniscalchi
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Marianna Conte
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Chiara Sepe
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Renato Maramaldi
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Salvatore Rega
- Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy;
| | - Giuseppe Russo
- Health Management Office, Antonio Cardarelli Hospital, 80131 Naples, Italy; (G.R.); (M.M.); (E.R.)
| | - Massimo Majolo
- Health Management Office, Antonio Cardarelli Hospital, 80131 Naples, Italy; (G.R.); (M.M.); (E.R.)
| | - Eliana Raiola
- Health Management Office, Antonio Cardarelli Hospital, 80131 Naples, Italy; (G.R.); (M.M.); (E.R.)
| | - Andrea Salzano
- IRCCS SYNLAB SDN, Via Emanuele Gianturco, 113-80143 Naples, Italy; (B.R.); (M.F.); (R.C.); (A.S.)
| | - Ciro Mauro
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (B.T.); (R.I.)
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, “Federico II” University of Naples, 80131 Naples, Italy; (B.T.); (R.I.)
| | - Eduardo Bossone
- Division of Cardiology, A Cardarelli Hospital, 80131 Naples, Italy; (V.C.); (R.C.); (S.C.); (R.A.); (F.M.); (M.S.); (M.C.); (C.S.); (R.M.); (C.M.)
- Correspondence:
| |
Collapse
|
4
|
Manzi MV, Mancusi C, Lembo M, Esposito G, Rao MAE, de Simone G, Morisco C, Trimarco V, Izzo R, Trimarco B. Low mechano-energetic efficiency is associated with future left ventricular systolic dysfunction in hypertensives. ESC Heart Fail 2022; 9:2291-2300. [PMID: 35481670 PMCID: PMC9288798 DOI: 10.1002/ehf2.13908] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/16/2022] [Accepted: 03/11/2022] [Indexed: 01/19/2023] Open
Abstract
Aims In a hypertensive population with optimal blood pressure control with a long‐term follow‐up, we aimed at analysing possible predictors of left ventricular (LV) ejection fraction (LVEF) reduction, including indexed mechano‐energetic efficiency (MEEi), a well‐recognized echo‐derived parameter of LV performance. Methods and results The study population included 5673 hypertensive patients from the Campania Salute Network with a long‐term follow‐up, normal baseline LVEF (≥50%), and no prevalent cardiovascular (CV) disease. Patients developing LVEF impairment (LVEF < 50% or a reduction of at least 10 percentage points compared with baseline) were compared with patients with persistently normal LVEF. Optimal blood pressure control was achieved in about 80% of patients. Patients who experienced LVEF reduction were 2.41% during a long‐term follow‐up (mean duration 5.6 ± 3.9 years). At baseline, they were older (59.46 ± 11.58 vs. 53.40 ± 11.41, P < 0.0001) and showed higher LV mass index (53.3 ± 12.83 vs. 47.56 ± 9.58, P < 0.0001), left atrial (LA) volume index (14.4 ± 4.2 vs. 13.1 ± 2.8, P < 0.0001) and carotid intima–media thickness (1.99 ± 0.86 vs. 1.61 ± 0.73, P < 0.0001), lower MEEi (0.32 ± 0.08 vs. 0.34 ± 0.07, P = 0.037), and higher prevalence of CV events during follow‐up (13.9% vs. 3%, P < 0.0001) compared with patients with persistently normal LVEF. A logistic regression analysis, performed after running univariate analyses and selecting parameters significantly associated with LVEF reduction, showed that having a CV event [odds ratio (OR) 7.57, P < 0.0001], being in the lowest MEEi quartile (OR 2.43, P = 0.003), and having a larger LA volume index (OR 1.08, P = 0.028) were all parameters independently associated with the development of LV systolic dysfunction. A further logistic regression model, performed by excluding patients experiencing CV events, demonstrated that the lowest MEEi quartile was independently associated with the evolution towards LVEF reduction (OR 2.35, P = 0.004), despite significant impact of LA volume index (OR 1.08, P = 0.023) and antiplatelet therapy (OR 1.89, P < 0.01). Receiver operating characteristic curves showed that the model including MEEi had higher accuracy than the model without MEEi in predicting LVEF reduction (areas under the curve 0.68 vs. 0.63, P = 0.046). Conclusions Lower values of MEEi at baseline identify hypertensive patients more liable to develop LVEF reduction. In hypertensive setting, MEEi evaluation improves risk stratification for development of LV systolic dysfunction during long‐term follow‐up.
Collapse
Affiliation(s)
- Maria V Manzi
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Costantino Mancusi
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Maria Lembo
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Giovanni Esposito
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | | | - Giovanni de Simone
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Carmine Morisco
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Valentina Trimarco
- Department of Neurosciences, Federico II University of Naples, Naples, Italy
| | - Raffaele Izzo
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| | - Bruno Trimarco
- Hypertension Research Center, Department of Advanced Biomedical Sciences, Federico II University of Naples, Via S. Pansini 5, Naples, 80131, Italy
| |
Collapse
|