Journal ArticleDOI
Myocardial mechano-energetic efficiency in hypertensive adults.
Giovanni de Simone,Marcello Chinali,Maurizio Galderisi,Margherita Benincasa,D Girfoglio,Ilaria Botta,Gianpaolo D'Addeo,Oreste de Divitiis +7 more
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TLDR
In some hypertensive patients the left ventricle works inefficiently with a high energy wasting, at the same level of LV mass as hypertensivePatients with normal myocardial mechanical efficiency feature a high cardiovascular risk phenotype, with concentric LV geometry, systolic dysfunction, and indirect signs of more severe vascular impairment.Abstract:
BACKGROUND Myocardial mechanical efficiency can be measured as the ratio between systolic work and energy consumption. We evaluated the relation between myocardial mechanical efficiency and left ventricular (LV) mass in untreated hypertensive patients. METHODS Myocardial work was estimated in 256 normotensive (35 +/- 12 years) and 306 hypertensive patients (47 +/- 10 years) with normal ejection fraction, as stroke work in gram-meters (stroke work = BPs x SV x 0.0144, where BPs is systolic blood pressure, SV is echocardiographic stroke volume). Myocardial O2 consumption was estimated as the product of heart rate (HR) x BPs (eMVO2). Myocardial mechanical efficiency was estimated as the ratio of stroke work/eMVO2, which can be simplified and expressed as ml/s. RESULTS LV mass was greater in hypertensive than in normotensive patients (46 +/- 13 vs. 38 +/- 11 g/m2.7, P < 0.0001), but myocardial mechanical efficiency was identical (85 +/- 23 vs. 86 +/- 26 ml/s). Relations between myocardial mechanical efficiency and LV mass were close (both P < 0.0001), but more scattered among hypertensive patients because of 56 patients exhibiting low myocardial mechanical efficiency relative to the magnitude of LV mass. At comparable age and body size, these patients had higher HR, BPs, and pulse pressure than those with normal myocardial mechanical efficiency (all P < 0.001). After adjusting for age and sex, hypertensive patients with low myocardial mechanical efficiency showed greater relative wall thickness and lower ejection fraction and midwall shortening than those with normal myocardial mechanical efficiency (all P < 0.001). Low myocardial mechanical efficiency was also associated with inappropriately high LV mass (P < 0.0001). CONCLUSION In some hypertensive patients the left ventricle works inefficiently with a high energy wasting, at the same level of LV mass as hypertensive patients with normal myocardial mechanical efficiency. Those patients feature a high cardiovascular risk phenotype, with concentric LV geometry, systolic dysfunction, and indirect signs of more severe vascular impairment.read more
Citations
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Journal ArticleDOI
Impaired left atrial function in heart failure with preserved ejection fraction
Angela B. S. Santos,Elisabeth Kraigher-Krainer,Deepak K. Gupta,Brian Claggett,Michael R. Zile,Burkert Pieske,Adriaan A. Voors,Marty P. Lefkowitz,Toni Bransford,Victor Shi,Milton Packer,John J.V. McMurray,Amil M. Shah,Scott D. Solomon +13 more
TL;DR: Left atrial enlargement is present in the majority of heart failure with preserved ejection fraction patients and is a marker of risk, however, the importance of LA function in HFpEF is less well understood.
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Contrast echocardiography for assessing left ventricular vortex strength in heart failure: a prospective cohort study
Haruhiko Abe,Haruhiko Abe,Haruhiko Abe,Giuseppe Caracciolo,Giuseppe Caracciolo,Giuseppe Caracciolo,Arash Kheradvar,Gianni Pedrizzetti,Gianni Pedrizzetti,Gianni Pedrizzetti,Bijoy K. Khandheria,Jagat Narula,Jagat Narula,Partho P. Sengupta,Partho P. Sengupta +14 more
TL;DR: The preliminary data suggest that the persistence of vortex from late diastole into IC is a haemodynamic measure of coupling between diastoles and systole and shows association with adverse clinical outcomes seen in HF patients.
Journal ArticleDOI
Cardio-ankle vascular index and subclinical heart disease
TL;DR: A high CAVI is associated with inappropriately high left ventricular mass and low midwall systolic function, and as a marker of arterial diastolic-to-systolic stiffening, CAVI may have a relationship withleft ventricular structure and function that is independent of blood pressure levels.
Journal ArticleDOI
Depressed myocardial energetic efficiency is associated with increased cardiovascular risk in hypertensive left ventricular hypertrophy.
Giovanni de Simone,Raffaele Izzo,Maria Angela Losi,Eugenio Stabile,Francesco Rozza,Grazia Canciello,Costantino Mancusi,Valentina Trimarco,Nicola De Luca,Bruno Trimarco +9 more
TL;DR: A simple estimate of low myocardial mechano-energetic efficiency is associated with altered metabolic profile,LVH, concentric left ventricular geometry, and diastolic dysfunction and predicts cardiovascular end-points, independently of age, sex, LVH antihypertensive therapy, and cardiovascular risk factors.
Journal ArticleDOI
Effect of diabetes and metabolic syndrome on myocardial mechano-energetic efficiency in hypertensive patients. The Campania Salute Network.
Costantino Mancusi,M A Losi,Raffaele Izzo,Grazia Canciello,Maria Virginia Manzi,Alfonso Sforza,N. De Luca,Bruno Trimarco,G. De Simone +8 more
TL;DR: Both MetS and DM are associated with decreased MEEi in hypertensive patients, independently to each other, but the reduction is statistically less evident for MetS−/DM+.
References
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Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate.
Andrew S. Levey,Josef Coresh,Tom Greene,Lesley A. Stevens,Yaping (Lucy) Zhang,Stephen Hendriksen,John W. Kusek,Frederick Van Lente +7 more
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Giovanni de Simone,Stephen R. Daniels,Stephen R. Daniels,Richard B. Devereux,Richard A. Meyer,Richard A. Meyer,Mary J. Roman,Oreste de Divitiis,Michael H. Alderman,Michael H. Alderman +9 more
TL;DR: Normalizations of left ventricular mass for height or body surface area introduce artifactual relations of indexed ventricularmass to body size and errors in estimating the impact of overweight, which are avoided and variability among normal subjects is reduced.
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