Non-invasive myocardial work indices in arterial hypertension: relevance to hypertension grade assessed by 24-hour blood pressure monitoring

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background. A novel approach to non-invasive myocardial work (MW) assessment was shown to be of clinical value in different scenarios. It based on left ventricle (LV) pressure-global longitudinal strain (GLS) loops computation. Systolic LV pressure is assumed to be equal to brachial cuff systolic pressure. However, single blood pressure (BP) measurement during echocardiography may be influenced by many factors, e.g. «white-coat» effect. The purpose of this study was to evaluate MW indices in patients from mild to severe arterial hypertension (AH) assessed by 24-hour ambulatory blood pressure monitoring. Methods. The study enrolled 90 males (mean age 47 ± 9 years) with uncomplicated arterial hypertension (AH), divided into 3 groups (mild AH, moderate AH, severe AH). All patients underwent conventional echocardiography, speckle tracking echocardiography with LV pressure-strain loops computation and 24-hour BP monitoring at the same day. The AH grade was assessed by DABL criteria. MV indices were calculated with specific software by integrating LV global longitudinal strain data and non-invasively estimated LV pressure. The following parameters were calculated: global work index (GWI), global constructive work (GCW), global wasted work (GWW) and global work efficiency (GWE). The values are given as median and interquartile range. Results. The patients in groups were comparable by demographic and clinical characteristics. We didn"t find any difference between groups by conventional echocardiographic parameters, including LV wall thickness, LV mass index, LV ejection fraction and LV GLS. The significant difference was present between three groups in all MW indices (Table). The patients with severe AH had higher GWI, as well as GCW and GWW compared to patients with mild and moderate AH. The GWE was significantly decreased in patients with highest BP values. Conclusions. Myocardial work indices are more sensitive markers of LV function in patients with AH compared to standard parameters. Integration of systolic BP, assessed by 24-hour BP monitoring in MW analysis may potentially give more precise characteristics of LV function in hypertensive patients. Abstract Figure.