Abnormal left ventricular function occurs on exercise in well-treated hypertensive subjects with normal resting echocardiography

Tan, Yu Ting; Wenzelburger, Frauke; Lee, Eveline; Heatlie, Grant; Frenneaux, Michael; Sanderson, John E.

doi:10.1136/hrt.2009.185181

Cited by 35 publications

(50 citation statements)

References 37 publications

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“…49 In addition to impairment in microcirculation, myocardial structure is altered during the process of hypertensive heart disease and apoptosis, and fibrosis may contribute to hypertensive LV remodelling and reduced LV contractility. 50 In hypertensive patients older than 70 years of age, 51 LV contractility may be impaired at stress possibly as the result of myocardial fibrosis compared with the relatively younger groups. 32,44,45 It has been reported that AT1 receptor blocker agent used in this subset of patients may lead to a decrease in destruction of cardiomyocytes and halt the progressive fibrosis.…”

Section: Sympathetic Stimulation and Dynamics In Hypertension-mediatementioning

confidence: 99%

Quantitative left ventricular contractility analysis under stress: a new practical approach in follow-up of hypertensive patients

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et al. 2010

J Hum Hypertens

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Excessive sympathetic activity and stress-induced left ventricular (LV) hypercontractility have been described in hypertensive LV hypertrophy. Recent quantitative data have shown that hypertensive LV hypertrophy is associated with preserved global LV function. However, progression of uncontrolled hypertension have detrimental effects on both the ejection fraction (EF) and LV contractile response to stress. Hypertensive LV hypertrophy has some common characteristics, including preserved global LV systolic function and LV volume with heart failure with preserved EF (HFPEF), which makes it difficult to differentiate between the two conditions at rest. Studies suggest that adopting an efficient antihypertensive therapy regimen may positively effect on the LV contractile capability in patients with long-standing hypertension. Evaluation of quantitative LV contractility under stress may be beneficial to differentiate between the hypertensive LV hypertrophy and HFPEF. It may also assist in developing a more effective modality in medical management of patients with hypertensive heart disease.

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Section: Sympathetic Stimulation and Dynamics In Hypertension-mediatementioning

confidence: 99%

Quantitative left ventricular contractility analysis under stress: a new practical approach in follow-up of hypertensive patients

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Küçukler

et al. 2010

J Hum Hypertens

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“…26-28 Patients with treated hypertension and breathlessness on exertion have been shown to develop marked abnormalities of both systolic and diastolic function involving longitudinal function, torsion and twist despite normal echocardiograms at rest and without evidence of ischemia. 27 These studies also suggest that other factors relating to myocardial tissue or matrix changes might have significant effects on LV function especially on exercise. Dyssynchrony might be one such factor that results from these structural changes.…”

Section: Discussionmentioning

confidence: 98%

Left Ventricular Mechanical Dyssynchrony Impairs Exercise Capacity in Patients With Coronary Artery Disease With Preserved Left Ventricular Systolic Function and a QRS Duration ≤120ms

Wang

Yan

Yue

et al. 2012

Circ J

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Background: Left ventricular (LV) mechanical dyssynchrony can lead to impairment of LV function and is associated with adverse clinical outcomes in coronary artery disease (CAD) patients. The impact of LV dyssynchrony on exercise capacity (EC) in patients with CAD was investigated. Methods and Results:An echocardiographic examination with tissue Doppler imaging and exercise treadmill testing in 151 CAD patients with normal LV ejection fraction was performed. LV intra- and inter-ventricular dyssynchrony were defined by the standard deviation of time interval between LV 6 basal segments (Ts-SD), and the time interval from the right ventricular (RV) free wall to LV lateral wall (Ts-RV) respectively, and EC was measured as metabolic equivalents (METs) on the treadmill. Patients with impaired EC (defined by a METs ≤8, which is the mean MET of the study population) were older (71±7 vs. 62±2 years, P<0.01), however, there were no differences in gender and clinical status such as prevalence of prior myocardial infarction (MI), regional wall motion abnormality (RWMA), and coronary revascularization between patients with (n=90) or without (n=61) impaired EC. Univariate analysis showed that age, body mass index, LV systolic and diastolic volume, mitral inflow A velocity, and Ts-SD were all significantly associated with METs (all P<0.05). However, multivariate regression analysis revealed that old age (odd ratio [OR]: 1.136, 95% confidence interval [CI]: 1.080-1.196, P<0.001), and Ts-SD (OR: 1.026, 95%CI: 1.003-1.049, P=0.027) only were independent predictors for impaired EC. Conclusions:In patients with CAD, LV systolic dyssynchrony predicts impaired EC independently of history of previous MI or RWMA. (Circ J 2012; 76: 682 - 688)

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“…In patients with dysfunctional LV myocardium, plastic deformation has been pointed out, which can be validated experimentally and clinically and permits certain predictions with respect to identifying responders and non-responders to medical and device therapies (2). In chronic disease setting, diagnostic application of stress induction can be used for risk stratification and contractile parameters may be blunted under stress (20,22). It has been documented that medical and device therapies may not be effective in some chronic patients.…”

Section: Introductionmentioning

confidence: 99%

“…Recently, we have published a report to point out some important geometric and functional aspects of hypertensive heart disease to differentiate from ASC for exact diagnosis of controversial cases (18). Tissue Doppler Imaging (TDI) permits a quantitative assessment of both global and regional function (19) and we and others used TDI for quantitative myocardial contractility analysis combined with stress in hypertension (14,20). We suggested that quantitative tissue analysis under stress in patients who are on effective treatment may contribute to better follow-up and may be beneficial for hypertrophy regression with reverse remodeling in hypertensive heart disease (21).…”

Section: Introductionmentioning

confidence: 99%

Complete reverse remodeling in acute stress cardiomyopathy. Is preserved tissue contractility under stress related to reverse remodeling

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et al. 2013

Anadolu Kardiyol Derg

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Acute stress cardiomyopathy is the unique disease which represents exaggerated and dysfunctional regions of the same cardiac tissue at the same episode. The impressive clinical course which involves the specific region is the stress-mediated exaggerated function of LV base under acutely developed stress induction. After abolishment of stress induction, dysfunctional part of LV which is the midapical myocardium undergoes a complete tissue functional recovery. The evolution of reverse remodeling in acute stress cardiomyopathy has been described using 2 and 3-dimensional echocardiography in the literature. This is the second report regarding reverse LV remodeling in acute stress cardiomyopathy in which we rather evaluate the underlying mechanisms leading complete reverse LV remodeling of dysfunctional myocardium. Therefore, we focus on the existence of preserved and exaggerated regional tissue under stress which possibly represents the predicted myocardial tissue recovery in this acute clinical entity. We also discuss the potential contribution of short-term disease course and lack of prior disease episodes to complete reverse remodeling differently from the heavy burden of chronic diseases leading to permanent tissue jeopardy. (Anadolu Kardiyol Derg 2014; 14: 73-5)

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Abnormal left ventricular function occurs on exercise in well-treated hypertensive subjects with normal resting echocardiography

Cited by 35 publications

References 37 publications

Quantitative left ventricular contractility analysis under stress: a new practical approach in follow-up of hypertensive patients

Quantitative left ventricular contractility analysis under stress: a new practical approach in follow-up of hypertensive patients

Left Ventricular Mechanical Dyssynchrony Impairs Exercise Capacity in Patients With Coronary Artery Disease With Preserved Left Ventricular Systolic Function and a QRS Duration ≤120ms

Complete reverse remodeling in acute stress cardiomyopathy. Is preserved tissue contractility under stress related to reverse remodeling

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