Myocardial mechano-energetic efficiency in hypertensive adults

Simone, Giovanni de; Chinali, Marcello; Galderisi, Maurizio; Benincasa, Margherita; Girfoglio, Daniela; Botta, Ilaria; D'Addeo, Gianpaolo; Divitiis, Oreste de

doi:10.1097/hjh.0b013e328320ab97

Cited by 46 publications

(67 citation statements)

References 41 publications

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“…6 Other unfavourable characteristics of concentric LV hypertrophy are the reduced coronary blood flow reserve 7 and the lower myocardial mechano-energetic efficiency. 8 All these characteristics, strongly support the view that concentric LVH is associated with the greatest CV risk.…”

supporting

confidence: 60%

“…At a given blood pressure and normal ejection fraction, the combination of increased relative wall thickness with normal LVM generates reduced LV chamber volume and consequent reduction of pump performance (stroke volume), which cannot be a favorable condition. 8 Overall, these characteristics make plausible that concentric LV remodeling is significantly related to adverse CV outcome, but the epidemiologic demonstration is not yet unequivocal. The reasons are different.…”

mentioning

confidence: 99%

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Cardiovascular risk in subjects with left ventricular concentric remodeling: Does meta-analysis help reconcile inconsistent findings?

Simone

Marco

2011

J Hum Hypertens

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Classification of the different left ventricular (LV) geometric patterns, based on measurement of LV mass (LVM) and relative wall thickness (that is, the wall thickness normalized by LV chamber radius) helps identifying distinctive pathophysiologic mechanisms.1,2 Whether or not the type of LV geometry adds to the prognostic value of increased LVM has been object of a number of clinical and epidemiological observations. 3,4 In particular, concentric LV hypertrophy (LVH) is the phenotypic condition associated with more severe hemodynamic and structural abnormalities and, is commonly assumed to be the most unfavourable cardiovascular (CV) phenotype.2 In addition to the wide evidence provided by a number of studies, 3,4 concentric LVH is characterized by an increase in LVM exceeding the compensatory needs due to the increased cardiac load, 5 a condition almost invariably associated with depressed myocardial function and early diastolic dysfunction. 6 Other unfavourable characteristics of concentric LV hypertrophy are the reduced coronary blood flow reserve 7 and the lower myocardial mechano-energetic efficiency.8 All these characteristics, strongly support the view that concentric LVH is associated with the greatest CV risk.Consistent with a very traditional view, concentric LV geometry might be a compensatory response to pressure overload, to reduce wall stress. However, cardiomyocyte hypertrophy and structural disarray produced by continuous pressure overload and neurohormonal activation, despite apparently protecting LV chamber function from early impairment, also cause abnormal LV systolic function and distensibility, 9 visible at the midwall level.10 Thus, the ability to reduce wall stress is not a convenient consequence of concentric LV geometry 11 and does not seem substantial to protect LV chamber function. 12The question of whether the consequences of these negative structural alterations and functional effects are typical of LVH or specifically tied with concentric LV geometry has been addressed in humans also by studying LV concentric remodeling, 13 the condition in which LV geometry is concentric, but the increase in LV mass does not fall in the range of clear-cut LVH.1 Thus, it has been proposed that LV concentric geometry by itself carries prognostic information beyond that provided by LVM and evaluation of LVH, after demonstration of a negative outcome in hypertensive patients with concentric LV remodeling 13 and confirmed, thereafter, in the elderly cohort of the Cardiovascular Health Study and other studies.14 This finding, however, has been challenged in the analysis performed using the large Framingham cohort,15 other less large studies 14 and in a further recent analysis performed in a large cohort of hypertensive outpatients, demonstrating that LVM is the strongest predictor of CV events, whereas the additional information from LV geometry and function (both systolic and diastolic) does not improve the accuracy of the prediction of the CV risk obtained by the sole LVM. 16 In this issue of t...

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supporting

confidence: 60%

mentioning

confidence: 99%

Cardiovascular risk in subjects with left ventricular concentric remodeling: Does meta-analysis help reconcile inconsistent findings?

Simone

Marco

2011

J Hum Hypertens

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“…In the calculation of end-systolic wall stress, end-systolic BP obtained from carotid waveform was used together with end-systolic LV diameter and posterior wall thickness. LV mechanical efficiency was estimated as the ratio between the stroke volume and the time of cardiac cycle [22]. Transmitral flow velocities were examined by pulsed Doppler from the apical four-chamber view; early inflow velocity (E V ) and early time-velocity integral (E VTI ) and atrial inflow velocity (A V ) and atrial timevelocity integral (A VTI ) were measured, and E V /A V ratio as well as the total area under transmitral inflow (E VTI þ A VTI ) were calculated.…”

Section: Echocardiographic Examination and Offline Analysesmentioning

confidence: 99%

Impact of prolonged cardiac unloading on left ventricular mass and longitudinal myocardial performance: an experimental bed rest study in humans

Kozàkovà

Malshi

Morizzo

et al. 2011

Journal of Hypertension

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“…This trend toward higher values of LV mass was also associated with an opposite trend toward lower stroke work in patients with CKD, resulting in a fall of LV mechano-energetic efficiency, which could be also more pronounced if normalized for grams of LV mass. [17] A lower MFS has already been detected in studies in paediatric populations with CKD from stage 2 to 5, [27] and in adult patients undergoing haemodialysis. [28] In these studies, LV concentric geometry was substantially prevalent, conditioning the relationship between LV chamber function and midwall mechanics, possibly because of a more advanced stage of the disease studied.…”

Section: Discussionmentioning

confidence: 92%

“…Total external myocardial work can be estimated as stroke work (SW), with SW being computed as: SW = SBP · SV · 0.014; where SV is echocardiographic stroke volume, SBP is systolic BP and the term 0.014 converts mmHg · cm 3 to grammeters. [17] To estimate mean oxygen consumption (MV O 2 ), we used the product between heart rate (HR) and SBP called 'double product' (DP). Thus, in the present study: MV O 2 » DP = HR · SBP; where SBP was taken by cuff sphygmomanometers at the end of the echocardiograph examination.…”

Section: Echocardiographic Measurementsmentioning

confidence: 99%

Preclinical Systolic Dysfunction in Patients with Stage 3 Chronic Kidney Disease

Morgillo

Chinali

Pota

et al. 2010

High Blood Pressure & Cardiovascular Prevention

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Introduction: Chronic kidney disease (CKD) is associated with increased cardiovascular risk and mortality. We evaluated whether stage 3 (s3)-CKD is associated with abnormalities of the cardiovascular system. Methods: Thirty-nine asymptomatic s3-CKD patients, free of prevalent cardiovascular disease, were compared with 44 control subjects with comparable prevalence of hypertension (66% vs 69% in s3-CKD). In addition to standard echocardiographic parameters, we computed non-invasive effective arterial elastance (EAE, in mmHg mL beat), systolic left ventricular elastance (LVe, in mmHg mL) and myocardial mechanic efficiency (MME, in mL sec), using previously reported formulas. Results: s3-CKD and controls were comparable for age, sex, lipid profile and prevalence of diabetes mellitus and smoking habit. Left ventricular (LV) mass, geometry and stroke work were similar in the two groups, with both ejection fraction and midwall shortening (mS) significantly reduced in the CKD group (both p < 0.001). Within the s3-CKD group, 36% had clear-cut depressed mS. EAE and peripheral resistance were higher in s3-CKD than in controls (both p < 0.005), and MME was reduced in CKD (p < 0.005), an impairment even clearer after controlling for LV mass, and increasing with increasing values of LV mass (p < 0.001). In addition, at a given level of peripheral resistance, LV geometry was less concentric in s3-CKD than in controls (p < 0.05). Conclusions: s3-CKD asymptomatic patients show a peculiar cardiovascular phenotype, characterized by impaired mechano-energetic efficiency and reduced midwall mechanics, in the presence of inadequately compensating LV concentric remodelling. Whether these characteristics might result in higher cardiovascular risk in s3-CKD should be investigated.

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Myocardial mechano-energetic efficiency in hypertensive adults

Cited by 46 publications

References 41 publications

Cardiovascular risk in subjects with left ventricular concentric remodeling: Does meta-analysis help reconcile inconsistent findings?

Cardiovascular risk in subjects with left ventricular concentric remodeling: Does meta-analysis help reconcile inconsistent findings?

Impact of prolonged cardiac unloading on left ventricular mass and longitudinal myocardial performance: an experimental bed rest study in humans

Preclinical Systolic Dysfunction in Patients with Stage 3 Chronic Kidney Disease

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