Low mechano‐energetic efficiency is associated with future left ventricular systolic dysfunction in hypertensives

Abstract

AimsIn 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 resultsThe 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.

Physiologic Range of Myocardial Mechano-Energetic Efficiency among Healthy Subjects: Impact of Gender and Age

“…However, although MEE can be quantified by dual-sided heart catheterization and selective catheterization of the coronary sinus, its widespread clinical applications have been limited by the need of invasive measurements requiring complex calculations [ 1 ]. In this regard, the availability of a surrogate measure of MEE based on a non-invasive echocardiographic approach allows more extensive clinical applications [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Indeed, strong evidence exists supporting the role of non-invasively derived indexed MEE (MEEi) in predicting cardiovascular (CV) clinical outcomes, with altered values associated with CV risk factors/disease such as insulin resistance and diabetes, hypertension, obesity, heart failure with preserved ejection fraction (HFpEF) [ 2 , 3 , 4 , 5 , 6 , 7 ].…”

“…In this regard, the availability of a surrogate measure of MEE based on a non-invasive echocardiographic approach allows more extensive clinical applications [ 2 , 3 , 4 , 5 , 6 , 7 , 8 ]. Indeed, strong evidence exists supporting the role of non-invasively derived indexed MEE (MEEi) in predicting cardiovascular (CV) clinical outcomes, with altered values associated with CV risk factors/disease such as insulin resistance and diabetes, hypertension, obesity, heart failure with preserved ejection fraction (HFpEF) [ 2 , 3 , 4 , 5 , 6 , 7 ]. Therefore, the aim of the present study was to explore the full range of MEE and MEEi values (as calculated by standard transthoracic Doppler echocardiography (TTE)) in a large cohort of healthy subjects, evaluating clinical and echocardiographic correlates.…”

Determinants of improvement of left ventricular mechano-energetic efficiency in hypertensive patients

“…The latter is related to increased oxygen consumption possibly linked to augmented heart rate, increased LV mass and insulin resistance leading to enhanced fatty acid oxidation (39)(40)(41). Low MEEi values, indeed, were showed to be a reliable predictor of cardiovascular events and heart failure and values below 0.29 of this index were demonstrated to be associated with systolic dysfunction and LVEF reduction (10).…”

“…Left ventricular ejection fraction and stroke volume were computed as the difference between LV end- diastolic and end-systolic volume by the z-derived method and indexed for height to the power of 2.04 ( 28 , 29 ). LVEF was considered reduced for values less than 50% at final echo or for a LVEF reduction of at least 10 percentage points compared to baseline ( 10 , 30 , 31 ).…”

“…MEEi was demonstrated to be a strong predictor of cardiovascular events and heart failure onset in multiple settings, including arterial hypertension (6)(7)(8)(9). In fact, low MEEi values were recently demonstrated to be able to identify patients more prone to develop LV systolic dysfunction, in terms of LV ejection fraction (LVEF) reduction, in a group of hypertensive patients with optimal blood pressure (BP) control during a long-term follow up (10).…”