Impact of blood pressure changes on myocardial work indices in hypertensive patients in a day

Abstract

Evaluating left ventricular function through instantaneous left ventricular deformation parameters might not always be accurate for patients with high fluctuations in blood pressure value due to afterload dependence. Myocardial work (MW) is a more advanced tool that combines global myocardial longitudinal strain (GLS) with LV (left ventricular) systolic pressure. The purpose of this study was to investigate the effect of blood pressure changes on MW indices in the population with normal blood pressure and hypertension in a day. A total of 117 participants (34 control subjects and 83 hypertensive patients) underwent echocardiographic measurements at rest, twice a day. Simultaneously, the brachial blood pressure was also measured. LV pressure-strain loop (PSL) was used to calculate global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE). The differences in the GLS and MW indices between the groups were compared, and the correlation of blood pressure changes with the changes in GLS and MW indices were evaluated.Compared to the control group, the hypertensive group showed higher GWI, GCW, and GWW but lower GLS and GWE. Absolute changes in blood pressure, GLS, and MW indices in hypertensive patients were significantly higher than that of the control subjects. Blood pressure changes had significant univariate correlation with changes in GLS and MW indices. In conclusion, significant fluctuations in blood pressure could induce changes in MW indices to preserve left ventricular systolic function. Repeated assessment of MW indices is necessary for hypertensive patients with large blood pressure fluctuations.

Myocardial Work in Echocardiography

“…19 In 83 patients with hypertension, higher blood pressures within the same day also led to changes in global myocardial work. 20…”

Left ventricular pressure strain loops for evaluation on myocardial work in type 2 diabetic patients with or without hypertension

“…The increase of GWW may be related to the discordant shrinkage caused by the increase of wall stress. Because the increase of GCW can offset part of GWW, GWE is relatively stable [21]. Similarly, it was found that SBP was independently correlated with GWI, GCW and GWW, but not with GWE Figure 4 .…”

Clinical research progress of myocardial work in assessment and prediction of coronary artery disease in noninvasive pressure‐strain loop technique

“…Clinical assessment of LV systolic function in CAD provides a more accurate new indicator. PSL has also played an important role not only in the field of cardiology, but also in dilated cardiomyopathy, 52,53 hypertrophic cardiomyopathy, 54,55 right ventricular cardiomyopathy, 56 hypertension, 52,57 and the evaluation of cardiac synchronization therapy. 13,58,59 Changes in LVMW with exercise can also be an effective means of quantifying myocardial contractile reserve.…”