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.
Highlights
Systemic arterial hypertension (HTN) is the most common cardiovascular (CV) risk factor among patients affected by heart failure with preserved ejection fraction (HFpEF) [1,2].In this regard, left ventricular hypertrophy (LVH) along with abnormal left ventricular (LV) relaxation and left atrial enlargement represents the characteristic “pathologic triad”usually detected by transthoracic Doppler echocardiography (TTE) in hypertensive patients as a direct consequence of the chronically increased Left ventricular (LV) workload [3,4]
exercise Doppler echocardiography (EDE) is commonly used in different settings, such as ischemic heart disease [21], valvular heart disease [22] and chronic heart failure [23], including patients with HFpEF who presented with heart failure symptoms during exercise and are characterized as having ‘borderline’ LV diastolic dysfunction [23,24]
Bossone et al showed that athletes have higher TRV compared with healthy control subjects both at rest and during exercise related to the higher left ventricular stroke volume (SV) and cardiac output (CO) reached [35]
Summary
Usually detected by transthoracic Doppler echocardiography (TTE) in hypertensive patients as a direct consequence of the chronically increased LV workload [3,4] It should be noted, in mild-moderate HTN, LV filling pressure and related pulmonary arterial systolic pressure (PASP) may be normal at rest but may show an abnormal and disproportionate increase during exercise [5,6]. 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. 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. Age and HTN have a synergic negative effect on E/E’ and TAPSE at peak exercise in hypertensive subjects
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