1
|
Lembo M, Acampa W, Elena Rao MA, Manzi MV, Morisco C, Esposito G, Assante R, Zampella E, Nappi C, Gaudieri V, Mannarino T, Mancusi C, de Simone G, Izzo R, Cuocolo A, Trimarco B. Left Ventricular Mechano-Energetic Efficiency Identifies an Early Impairment of Myocardial Blood Flow in Arterial Hypertension. Hypertension 2023. [PMID: 37170833 DOI: 10.1161/hypertensionaha.123.21071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
BACKGROUND Arterial hypertension causes cardiac functional and structural alterations. In hypertensive patients without flow-limiting epicardial coronary artery disease, we investigated possible relationships between positron emission tomography/computed tomography-derived myocardial blood flow (MBF) and echocardiographic parameters of left ventricular (LV) performance, including mechano-energetic efficiency indexed for myocardial mass (MEEi). METHODS Seventy-eight patients with hypertensive without flow-limiting epicardial coronary artery disease underwent echocardiography, including MEEi computation, and cardiac positron emission tomography/computed tomography with assessment of MBF/mass ratio at rest and after stress and myocardial flow reserve. The lowest MEEi tertile (MEEi<0.031 mL/s/g) was compared to the merged second and third tertiles (MEEi≥0.031). RESULTS Patients in the lowest MEEi tertile were older, had higher systolic blood pressure and body mass index. They also had higher prevalence of LV hypertrophy, whereas lower resting and stress MBF/mass ratio. MEEi was significantly correlated with both resting (r=0.51; P<0.0001) and hyperemic (r=0.54; P<0.0001) MBF/mass ratios, whereas it was not related to myocardial flow reserve. Delta of MBF/mass ratio was lower in the lowest MEEi tertile than in the highest (P<0.0001). In separate multiple linear regression models, after adjusting for sex, systolic blood pressure, prevalence of LV hypertrophy, left atrial volume index, and diuretic therapy, the association between LV MEEi and both hyperemic (beta coefficient=0.44; P=0.003) and resting (beta coefficient=0.35; P=0.008) MBF/mass ratio remained significant. CONCLUSIONS In patients with hypertensive without flow-limiting epicardial coronary artery disease, low values of MEEi could detect an early LV dysfunction involving an impairment of both resting and hyperemic MBF/mass ratios. MEEi has the advantage of simpler detection, cheaper costs than positron emission tomography/computed tomography, and a lack of radiation exposure. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT02211365.
Collapse
Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Wanda Acampa
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | | | - Maria Virginia Manzi
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Carmine Morisco
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Roberta Assante
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Emilia Zampella
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Carmela Nappi
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Valeria Gaudieri
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Teresa Mannarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Giovanni de Simone
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Alberto Cuocolo
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, Federico II University of Naples Naples, Italy. (M.L., W.A., M.V.M., C.M., G.E., R.A., E.Z., C.N., V.G., T.M., C.M., G.d.S., R.I., A.C., B.T.)
- International Translational Research and Medical Education (ITME) Consortium, Naples, Italy. (B.T.)
| |
Collapse
|
2
|
Lembo M, Acampa W, Elena Rao MA, Virginia Manzi M, Morisco C, Mancusi C, Esposito G, Cuocolo A, Izzo R, Trimarco B. 150 ECHO-DERIVED LEFT VENTRICULAR MECHANO-ENERGETIC EFFICACY CHARACTERIZES HYPERTENSIVE PATIENTS WITH IMPAIRED PET-DERIVED MYOCARDIAL BLOOD FLOW. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartjsupp/suac121.204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Abstract
Background
Chronic left ventricular (LV) pressure overload determines both morphological and functional alterations in the heart and in the vascular system with occurrence of LV hypertrophy, coronary rarefaction and metabolic impairment, predisposing to heart failure. We aim at investigating early cardiac involvement in hypertensive disease by both Positron emission tomography (PET) and echo assessment and possible associations between alterations of PET-derived myocardial blood flow (MBF) and echocardiographic parameters of LV performance including mechano-energetic efficiency indexed for myocardial mass (MEEi), in a population of symptomatic hypertensive patients without flow-limiting epicardial coronary artery disease (CAD).
Methods
The study population included 78 symptomatic hypertensive patients without flow-limiting epicardial CAD. All patients underwent standard echocardiographic assessment, including evaluation of LV MEEi, and PET assessment with evaluation of MBF and MBF/mass ratio at rest and after stress and myocardial flow reserve (MFR).
Results
The study population included 67% males, 55% with dyslipidaemia, 42% with smoking habits and 21% obese. Prevalence of LV hypertrophy was of 43%. Among parameters of LV systolic performance, hyperaemic MBF/mass ratio resulted significantly correlated with LV MEEi (r=0.54, p<0.0001), midwall fractional shortening (r=0.38, p=0.001) but not with LVEF (r=0.10, p=0.47). Similarly, resting MBF/mass ratio resulted to have statistically significant correlations with LV MEEi (r=0.51, p<0.0001), midwall fractional shortening (r=0.29, p=0.01) but not with LVEF (r=0.11, p=0.39). LV MEEi reached the highest correlation coefficient with both resting and stress MBF/mass ratio. On the other hand, the correlation between MEEi and MFR did not reach statistical significance (r=0.11, p=0.33).
In a multiple linear regression analysis, after adjusting for sex, systolic blood pressure, prevalence of LV hypertrophy and therapy with diuretics, the association between LV MEEi and hyperaemic MBF/mass ratio remained significant (beta coefficient =0.40, p=0.007). In a subsequent multivariate model, adjusting for the same confounders, by replacing hyperaemic MBF/mass ratio with resting MBF/mass ratio, LV MEEi and resting MBF/mass ratio continued to be significantly associated (beta coefficient =0.32, p=0.015).
Conclusions
In a population of hypertensive patients without flow-limiting epicardial CAD, an early myocardial impairment possibly related to coronary rarefaction and inadequate angiogenesis contributing to the altered myocardial metabolic demand and efficacy is detectable by both PET and echo-derived LV MEEi. Indeed, an independent association between LV MEEi and both MBF/mass ratio at rest and after stress exists, LV MEEi having the advantage over PET of being easily derived from standard echocardiography and not needing radiation exposure.
Collapse
|
4
|
Giudice R, Izzo R, Manzi MV, Pagnano G, Santoro M, Rao MAE, Di Renzo G, De Luca N, Trimarco V. Lifestyle-related risk factors, smoking status and cardiovascular disease. High Blood Press Cardiovasc Prev 2013; 19:85-92. [PMID: 22867094 DOI: 10.1007/bf03262458] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Cardiovascular disease represents one of the most important causes of morbidity and mortality in highly developed countries and is known to be associated with some lifestyle-related risk factors (e.g. alcohol consumption, smoking status, diet, physical activity, bodyweight). There is still incomplete information about their combined effect on cardiovascular risk in hypertensive patients with optimal pharmacological blood pressure control. AIM The objective of this study was to evaluate the correlation of some lifestyle behaviours, using a specific questionnaire, with development of cardiovascular disease in treated hypertensive patients. METHODS 617 hypertensive, non-diabetic participants (aged 53.1 ± 7.6 years, 44.9% male; mean age 53.1 ± 7.6 years) free of prevalent cardiovascular disease, cancer, liver cirrhosis and/or failure, chronic kidney disease more than grade 3 (glomerular filtration rate by the Modification of Diet in Renal Disease study <30 mL/min/1.73 m2) were analysed. Metabolic syndrome was defined according to the Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Left ventricular hypertrophy was defined when left ventricular mass index was >51 g/m2. Carotid artery atherosclerosis was assessed as an increased intima medial thickness (IMT) by B-mode ultrasonography. IMT values between 0.9 and 1.3 mm were defined as 'thickening' and those >1.3 mm as 'plaque'. Assessment of smoking status, dietary and non-dietary factors was established by administration of a specific questionnaire. RESULTS In the initial population of examined patients, 288 were smokers and 329 were non-smokers. At baseline, the patients belonging to smoking group were less often overweight than those belonging to the non-smoking group, showing a lower initial body mass index (BMI) [27.54 ± 4.0 vs 28.28 ± 4.3; p < 0.029], lower plasma levels of high-density lipoprotein cholesterol (HDL-C) [48.14 ± 12.6 vs 51.39 ± 14.1 mg/dL; p < 0.006] and were more often affected by carotid artery atherosclerosis (93.9 % vs 86.1%; p < 0.002) than non-smoking patients. When analysed for dietary and other lifestyle-related risk factors, we found a higher prevalence of carotid atherosclerotic disease in patients consuming less than two meals per day than in those consuming more than two meals per day (96.6% vs 85.7%; p < 0.001), without any significant difference in the mean number of medications taken and in specific classes of medications. Total amount of cigarettes smoked, calculated as packs per year (39.14 ± 16.5 vs 20.81 ± 13.6; p < 0.0001) was higher in patients with a diagnosis of atherosclerotic disease of the carotid artery than in patients free of this disorder, whereas the average age at which people began smoking was lower (17.58 ± 6.3 vs 21.53 ± 10.2 years). In a binary model of logistic regression adjusted for BMI, HDL-C, smoking status and number of daily meals, only smoking status was confirmed to be strongly correlated to clinical evidence of carotid atherosclerosis (p < 0.025). CONCLUSIONS In hypertensive patients, in optimal blood pressure control, smoking status has been shown to be independently associated with an increased maximum arterial IMT (IMTmax). In particular, an increase of the IMT was associated with the total amount of cigarettes smoked (calculated as packs per year) and the average age at which people began smoking.
Collapse
Affiliation(s)
- Renata Giudice
- Department of Clinical Medicine, Cardiovascular and Immunological Sciences, Federico II University, Naples, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|