Right Heart Pulmonary Circulation Unit Response to Exercise in Patients with Controlled Systemic Arterial Hypertension: Insights from the RIGHT Heart International NETwork (RIGHT-NET)

Abstract

Background. Systemic arterial hypertension (HTN) is the main risk factor for the development of heart failure with preserved ejection fraction (HFpEF). The aim of the study was was to assess the trends in PASP, E/E’ and TAPSE during exercise Doppler echocardiography (EDE) in hypertensive (HTN) patients vs. healthy subjects stratified by age. Methods. EDE was performed in 155 hypertensive patients and in 145 healthy subjects (mean age 62 ± 12.0 vs. 54 ± 14.9 years respectively, p < 0.0001). EDE was undertaken on a semi-recumbent cycle ergometer with load increasing by 25 watts every 2 min. Left ventricular (LV) and right ventricular (RV) dimensions, function and hemodynamics were evaluated. Results. Echo-Doppler parameters of LV and RV function were lower, both at rest and at peak exercise in hypertensives, while pulmonary hemodynamics were higher as compared to healthy subjects. The entire cohort was then divided into tertiles of age: at rest, no significant differences were recorded for each age group between hypertensives and normotensives except for E/E’ that was higher in hypertensives. At peak exercise, hypertensives had higher pulmonary artery systolic pressure (PASP) and E/E’ but lower tricuspid annular plane systolic excursion (TAPSE) as age increased, compared to normotensives. Differences in E/E’ and TAPSE between the 2 groups at peak exercise were explained by the interaction between HTN and age even after adjustment for baseline values (p < 0.001 for E/E’, p = 0.011 for TAPSE). At peak exercise, the oldest group of hypertensive patients had a mean E/E’ of 13.0, suggesting a significant increase in LV diastolic pressure combined with increased PASP. Conclusion. Age and HTN have a synergic negative effect on E/E’ and TAPSE at peak exercise in hypertensive subjects.

Efecto del alcohol sobre el corazón y el sistema cardiovascular: hipertrofia, remodelamiento y disminución del strain. Información actual

“…(51) Vriz y colaboradores realizaron ecocardiografía Doppler de ejercicio en un grupo de 155 pacientes hipertensos y en 145 sujetos normales, y documentaron que la TAPSE durante el ejercicio era menor en el grupo hipertenso mientras que la PSAP, así como su valor indexado al volumen minuto alcanzado durante el ejercicio, era mayor. (52) En un análisis llevado a cabo recientemente por nuestro grupo, la mediana y el rango intercuartilo (RIC) de la masa ventricular izquierda fue de 119 (91-155) g/m 2 en pacientes que bebían alcohol [mediana 30 UA por semana] vs. 93 (75-110) g/m 2 en un grupo control que bebía hasta 2 UA por semana, (p = 0,008); y el espesor parietal relativo en el grupo alcohólico fue de 0,5 (0,4-0,6) vs. 0,4 (0,4-0,4) en los controles; p = 0,001. En el mismo estudio, el strain longitudinal global (SLG) y los strain específicos de las capas del corazón mostraron valores absolutos menores en el grupo con abuso de alcohol en comparación con los controles.…”

Alcohol Impact on the Heart and Cardiovascular System - Hypertrophy, Remodeling and Strain Impairment - Contemporary State-of-the-Art

“…(51) Vriz and co-authors performed exercise Doppler echocardiography in a group of 155 hypertensive patients and in 145 healthy subjects, and documented that TAPSE during exercise was lower in the hypertensive group, whereas PASP as well as its value indexed to the cardiac output achieved during exercise was higher. (52) In a recently published analysis of our group, the median and interquartile range (IQR) of left ventricular mass index was 119 (91-155) g/m² in patients drinking alcohol (median 30 AU per week) vs. 93 (75-110) g/m² in a control group (drinking up to 2 AU per week), p = 0.008; and the relative wall thickness in the alcohol group was 0.5 (0.4-0.6) vs. 0.4 (0.4-0.4) in controls, p = 0.001. In the same study, global longitudinal strain (GLS) and layer strains showed lower absolute values in alcohol overusers as compared to controls.…”