Document Detail


Impact of hypertension on ventricular-arterial coupling and regional myocardial work at rest and during isometric exercise.
MedLine Citation:
PMID:  22622108     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: To understand better the mechanism of left ventricular (LV) remodeling related to hypertension, it is important to evaluate LV function in relation to the changes in loading conditions. The aim of this study was to investigate changes in conventional ventricular-arterial coupling indexes, LV strain, and a new index reflecting regional myocardial work assessed noninvasively at rest and during isometric exercise in a random sample including participants with normal blood pressure and those with hypertension.
METHODS: A total of 148 participants (53.4% women; mean age, 52.0 years; 39.2% with hypertension) underwent simultaneous echocardiographic and arterial data acquisition at rest and during increased afterload (handgrip exercise). End-systolic pressure was determined from the carotid pulse wave. Arterial elastance (Ea) and LV elastance (Ees) were calculated as end-systolic pressure/stroke volume and end-systolic pressure/end-systolic volume. Doppler tissue imaging and two-dimensional speckle tracking were used to derive LV longitudinal strain. Regional myocardial work (ejection work density [EWD]) was the area of the pressure-strain loop during ejection.
RESULTS: At rest, with adjustments applied, Ees (3.06 vs 3.71 mm Hg/mL, P = .0003), Ea/Ees (0.54 vs 0.47, P = .002) and EWD (670 vs 802 Pa/m(2), P = .0001) differed significantly between participants with normal blood pressure and those with hypertension. During handgrip exercise, Ea and Ea/Ees significantly increased (P < .0001) in both groups. Doppler tissue imaging and two-dimensional LV strain decreased in participants with hypertension (P ≤ .008). Only in subjects with normal blood pressure EWD significantly increased (+14.7%, P = .0009).
CONCLUSIONS: Although patients with hypertension compared with those with normal blood pressure have increased LV systolic stiffness and regional myocardial work to match arterial load at rest, they might have diminished cardiac reserve to increase myocardial performance, as estimated by EWD during isometric exercise.
Authors:
Tatiana Kuznetsova; Jan D'hooge; Malgorzata Kloch-Badelek; Wojciech Sakiewicz; Lutgarde Thijs; Jan A Staessen
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Publication Detail:
Type:  Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2012-05-22
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  25     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-07-24     Completed Date:  2012-12-18     Revised Date:  2013-06-24    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  882-90     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American Society of Echocardiography. Published by Mosby, Inc. All rights reserved.
Affiliation:
The Studies Coordinating Centre, Division of Hypertension and Cardiovascular Rehabilitation, University of Leuven, Leuven, Belgium. tatiana.kouznetsova@med.kuleuven.be
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MeSH Terms
Descriptor/Qualifier:
Adult
Blood Pressure
Carotid Arteries / physiopathology*,  ultrasonography
Elastic Modulus
Exercise Test
Female
Heart / physiopathology*
Humans
Hypertension / complications,  physiopathology*,  ultrasonography
Isometric Contraction*
Male
Middle Aged
Ventricular Dysfunction, Left / etiology,  physiopathology*,  ultrasonography
Grant Support
ID/Acronym/Agency:
294713//European Research Council
Comments/Corrections
Comment In:
J Am Soc Echocardiogr. 2012 Aug;25(8):891-4   [PMID:  22824174 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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