BackgroundThe left atrium reservoir function has an important role in the global cardiac performance and is determined by multiple cardiac and extra‐cardiac factors. A new parameter is introduced, the independent strain, which quantifies left atrium reservoir phase deformation during isovolumetric relaxation.AimsIs evaluated whether independent strain can identify intrinsic atrial myocardial damage in hypertension.Material and MethodsProspective observational study in which echocardiography was done to 50 hypertensive patients and 80 healthy volunteers. Myocardial deformation was evaluated with two‐dimensional speckle tracking and left atrium volumes were calculated whit 3D‐echocardiography.ResultsIn hypertensive patients, the indexed left atrium volume was greater than in the control group (34 ± 7.8 vs 24 ± 4.9 mL/m2); strain of pump (−5.7 ± 2.4% vs −17±3.5%) and reservoir phases (34 ± 9% vs 48 ± 10%) were worst. The minimum left atrium volume was higher (26 ± 10 vs 15 ± 8 mL) and left atrium independent strain was lower in hypertensive patients (4.0% vs 6.5%, P = .001). Left atrium independent strain only correlated with minimum left atrium volume (r = −.31, P = .048).DiscussionThe left ventricle longitudinal performance has an important contributing role in the left atrium reservoir function; despite this finding, the independent strain was unrelated to left ventricle longitudinal function.ConclusionIndependent strain can identify atrial myocyte contractile dysfunction in hypertension given the relative absence of hemodynamic loads during this period. Additionally, quantification of left atrium minimum volume suggests indirectly the presence of atrial myocyte contractile dysfunction.
Introdução: A hipertensão arterial sistêmica afeta mais de 1,2 milhão de pessoas no mundo. Apenas 35% dos pacientes hipertensos têm valores de pressão arterial controlados. Recentemente a denervação simpática renal (DSR) tem demonstrado diminuir significativamente os valores de pressão arterial nos pacientes com hipertensão arterial sistêmica resistente. Métodos: Estudo prospectivo, de braço único, observacional, multicêntrico, incluindo pacientes consecutivos submetidos a DSR. O objetivo primário foi avaliar os níveis da pressão arterial sistólica aos 30 dias de seguimento. O objetivo secundário foi determinar a ocorrência de qualquer evento adverso relacionado com o procedimento. Resultados: Foram incluídos os primeiros 20 pacientes submetidos a DSR. A média de pressão arterial antes do procedimento foi de 171,6/93,2 ± 15,5/11,3 mmHg, com média de uso de 4,1 ± 1,5 fármacos anti-hipertensivos por paciente. A taxa de sucesso foi de 95%, tendo sido aplicadas 11,1 ± 1,9 ablações por paciente. Foi observada diminuição média de 29 ± 21 mmHg (P = 0,009) na pressão arterial sistólica 30 dias após o procedimento. Não houve complicação associada ao procedimento. Conclusões: A DSR por cateter em pacientes da prática clínica diária diminuiu significativamente os valores de pressão arterial. Em nossa experiência, a DSR demonstrou ser factível e segura.
Background: The left ventricle (LV) journey in their transition from
hypertrophy to heart failure is marked by many subcellular events
partially understood yet. The moment in which the structural
abnormalities reach the umbral to induce myocardial dysfunction remains
elusive. Aims: To evaluate the anatomic-functional relationship between
LV wall thickness and longitudinal systolic dysfunction. Material and
Methods: We prospectively performed clinical history and transthoracic
echocardiogram on healthy individuals and patients with hypertension,
left ventricle ejection fraction (LVEF) ≥50%, and absence of heart
failure symptoms. Results: A total of 226 patients and 101 healthy
individuals were recruited. The distribution for sex was similar between
groups. The mean age was 67±13 years old in the patients, and 44% had
concentric LV hypertrophy. LVEF was identical in both groups (63±6%);
in contrast, global longitudinal strain (GLS) (-18.8±2.5% vs.
-20.4±2%) and mitral annulus plane systolic excursion (MAPSE) (13.8±2.8
vs. 15.5±2mm) were lower. ROC curve classified optimally decreased GLS
with LV septum thickness ≥13mm and decreased MAPSE with thickness ≥14mm.
Multivariable logistic regression found that LV septum thickness is the
only variable associated with longitudinal systolic dysfunction (OR=
1.1, CI95%= 1.05 – 1.15, p= 0.001, R squared= 0.38). Discussion: A
progressive increase in LV wall thickness due to myocyte hypertrophy and
interstitial expansion is associated with LV systolic longitudinal
dysfunction. Conclusions: Patients with moderate or severe ventricular
hypertrophy (septum ≥13mm) had longitudinal systolic dysfunction, GLS
decreases with minor structural change than MAPSE, and LVEF is
insensitive in detecting longitudinal myocardial dysfunction in patients
with hypertension.
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