Mechano-energetic Efficiency Research Articles

Inappropriate left ventricular mass after HELLP syndrome inappropriate LVM after HELLP syndrome.

Excessive left ventricular mass (LVM) results in inefficient LV work with energy waste leading to a negative prognostic effect. We aimed at investigating the presence of inappropriate LVM and calculating the myocardial mechano-energetic efficiency index (MEEi) in former pre-eclamptic (PE) women (with or without HELLP syndrome) compared to women who experienced HELLP syndrome without PE. In this cross-sectional study, women with a history of normotensive HELLP (n=32), PE without HELLP (n=59), and PE with HELLP (n=101) underwent echocardiography as part of the clinical CV work-up after their complicated pregnancies from 6months to 4years postpartum. We excluded women with comorbidities, including chronic hypertension, hypercholesterolemia, and obesity. LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was considered as the ratio between stroke work and "double product" (to approximate energy consumption), indexed to LVM. LV hypertrophy was present in 8-14% and concentric remodeling in 31-42% of women, without intergroup difference. LVM was inappropriate in one-third of normotensive former HELLP and in about one-half of PE with or without HELLP, with no difference among groups. Accordingly, without nominal difference, MEEi showed a tendency towards lower values in former pre-eclamptic individuals. Women with a history of HELLP syndrome, independently from the presence/absence of PE, showed inappropriate LVM in the first 4years after delivery, which may partially explain the elevated CV risk in these women compared to the general female population.

Obstructive sleep apnea is associated with depressed myocardial mechanoenergetics.

To evaluate the association between the myocardial mechanoenergetic efficiency index (MEEi) and the Apnea-Hypopnea Index (AHI) in the initial phase of obstructive sleep apnea (OSA) diagnosis. In this cohort study, we included a total of 382 eligible participants without cardiovascular disease in a tertiary outpatient clinic between January 2013 and January 2015. We recorded demographic, clinical, polysomnographic and echocardiographic variables of the patients. In addition, myocardial mechanoenergetic efficiency (MEE) and MEEi were calculated by an echocardiography-derived validated measurement. The mean (±SD) age of the participants was 48.47 ± 12.13, and male/female ratio was 287/95. Comparing with non-OSA, MEEi was significantly lower in OSA patients at all stages (0.35 ± 0.08 vs. 0.42 ± 0.05; p< .001). MEEi was negatively correlated with hypertension (r= -0.518, p< .001), body mass index (r= -0.382, p< .001), AHI (r= -0.656, p< .001), total apne (r= -0.525, p< .001), hypopnea (r= -0.415, p< .001), systolic pulmonary pressure (r= -0.318, p< .001), relative wall thickness (RWT; r= -0.415, p< .001), and positive correlated with left ventricular ejection fraction (r= 0.586, p< .001). According to multiple linear regression analysis AHI (β= -0.625, p< .001), total apnea (β= -0.402, p= .001), hypopnea (β= -0.395, p= .001), LV ejection fraction (β= 0.478, p< .001) and RWT (β= -0.279, p< .001) have an independent relationship with MEEi. MEEi was lower in OSA patients. A reduced MEEi may reflect a disturbance in energy use of the myocardium. Consequently, our results may provide insight into the mechanisms leading to structural cardiac diseases in OSA patients.

Low myocardial mechano-energetic efficiency is an independent predictor of prognosis in advanced chronic liver disease.

We aimed at investigating if a low myocardial mechano-energetic efficiency (MEE) with energy waste could be a feature of cirrhotic cardiomyopathy and predictive of poor prognosis. We retrospectively interrogated a large data set of 115 cirrhotic patients followed up for 6 years and compared with 50 healthy controls. Echocardiographic and haemodynamic parameters were assessed at baseline according with current guidelines. MEE was estimated by echocardiographic stroke volume (z-derived)/(heart rate × 0.6). Cirrhotic patients presented low peripheral vascular resistance, a compensatory hyperdynamic syndrome with increased cardiac work, left atrial and left ventricular (LV) dimension and mass. Systolic parameters and MEE were similar between patients and controls. Patients with cirrhosis and refractory ascites showed significantly lower MEE compared with both patients with treatable ascites and patients without ascites (1.68 ± 0.47 vs. 1.98 ± 0.64 and 1.80 ± 0.37 ml/s; P < 0.05). Increased age and heart rate and reduced body weight, cardiac dimension and work significantly correlated with lower MEE, mostly when compared nonalcoholic with alcoholic cirrhosis (1.65 ± 0.42 vs. 1.95 ± 0.56 ml/s respectively; P = 0.002). Among the cardiovascular parameters left atrium enlargement and reduced MEE were independent predictors of death. In advanced chronic liver disease left ventricular performance is blunted due to an energetically inefficient cardiac mechanical work which correlates with a poor prognosis. Therefore, the simple basal assessment of MEE can identify patients with a worst prognosis which requires a close follow-up.

Depressed myocardial mechano-energetic efficiency in subjects with dysglycemia

AimsEvidence indicate that 1 h post-load glucose levels (1hPG) ≥ 155 mg/dl identify amongst subjects with normal glucose tolerance (NGT) a new category of prediabetes (NGT 1 h-high). A compromised myocardial mechano-energetic efficiency (MEE) is associated with type 2 diabetes and predicts adverse cardiovascular outcomes. Herein, we explored the association between prediabetes conditions such as NGT 1 h-high, impaired fasting glucose (IFG) and impaired glucose tolerance (IGT) and a decreased MEE. MethodsMEE was assessed by an echocardiography-derived measure in 1467 non-diabetic individuals subdivided according to their glucose tolerance: NGT and 1-hPG < 155 mg/dl (NGT 1 h-low, n = 617), NGT 1 h-high (n = 210), isolated IFG (n = 237), and IGT (n = 403). ResultsSubjects with NGT 1 h-high, isolated IFG, and IGT displayed a higher myocardial oxygen consumption, and a decreased MEE in comparison to NGT 1 h-low group. MEE was inversely related to male sex, age, body mass index, total cholesterol, triglycerides, fasting and post-load glucose and insulin, C reactive protein, and positively correlated with insulin sensitivity estimated by the Matsuda index. In a stepwise multivariate linear regression model including several cardio-metabolic risk factors, 1hPG was the major predictor of MEE. ConclusionsSubjects with NGT 1 h-high, isolated IFG, and IGT have a raised myocardial oxygen consumption and a reduced MEE.

Sex-specific differences in left ventricular mass and myocardial energetic efficiency in non-diabetic, pre-diabetic and newly diagnosed type 2 diabetic subjects

BackgroundWomen with type 2 diabetes (T2DM) have a higher excess risk for cardiovascular disease (CVD) than their male counterparts. However, whether the risk for CVD is higher in prediabetic women than men is still debated. We aimed to determine whether sex-related differences exist in left ventricular mass index (LVMI), and myocardial mechano-energetic efficiency (MEEi) in with normal glucose tolerant (NGT), pre-diabetic and newly diagnosed type 2 diabetic subjects.MethodsSex-related differences in LVMI and myocardial MEEi, assessed by validated echocardiography-derived measures, were examined among 1562 adults with NGT, prediabetes, and newly diagnosed T2DM, defined according to fasting glucose, 2-h post-load glucose, or HbA1c.ResultsWorsening of glucose tolerance in both men and women was associated with an increase in age-adjusted LVMI and myocardial MEEi. Women with newly diagnosed T2DM exhibited greater relative differences in LVMI and myocardial MEEi than diabetic men when compared with their NGT counterparts. Prediabetic women exhibited greater relative differences in myocardial MEEi, but not in LVMI, than prediabetic men when compared with their NGT counterparts. The statistical test for interaction between sex and glucose tolerance on both LVMI (P < 0.0001), and myocardial MEEi (P < 0.0001) was significant suggesting a sex-specific association.ConclusionsLeft ventricle is subject to maladaptive changes with worsening of glucose tolerance, especially in women with newly diagnosed T2DM. The sex-specific increase in LVM and decrease in MEEi, both being predictors of CVD, may have a role in explaining the stronger impact of T2DM on the excess risk of CVD in women than in men.

Does left ventricular function predict cardiac outcome in Anderson\u2013Fabry disease?

In Anderson–Fabry disease (AFD) the impact of left ventricular (LV) function on cardiac outcome is unknown. Noninvasive LV pressure–strain loop analysis is a new echocardiographic method to estimate myocardial work (MW). We aimed to evaluate whether LV function was associated with outcome and whether MW had a prognostic value in AFD. Ninety-six AFD patients (41.8 ± 14.7 years, 43.7% males) with normal LV ejection fraction were retrospectively evaluated. Inclusion criteria were sinus rhythm and ≥ 2-year follow-up. Standard echocardiography measurements, myocardial mechano-energetic efficiency (MEE) index, global longitudinal strain (GLS) and MW were evaluated. Adverse cardiac events were defined as composite of cardiac death, malignant ventricular tachycardia, atrial fibrillation and severe heart failure development. During a median follow-up of 63 months (interquartile range 37–85), 14 events occurred. Patient age, cardiac biomarkers, LV mass index, left atrium volume, E/Ea ratio, LV ejection fraction, MEE index, GLS and all MW indices were significantly related to adverse outcome at univariate analysis. After adjustment for clinical and echocardiographic parameters, which were significant at univariate analysis, GLS and MW resulted independent predictors of adverse events (p < 0.01). By ROC curve analysis, constructive MW ≤ 1513 mmHg% showed the highest sensitivity and specificity in predicting adverse outcome (92.9% and 86.6%, respectively). MW did not improve the predictive value of a model including clinical data, LV diastolic function and GLS. LV function impairment (both systolic and diastolic) is associated with adverse events in AFD. MW does not provide additive information over clinical features and systolic and diastolic function.

Predictors and prognostic role of low myocardial mechano-energetic efficiency in chronic inflammatory arthritis.

To assess the variables associated with the status of low myocardial mechano-energetic efficiency (MEE) [the ratio between myocardial left ventricular (LV) work and magnitude of myocardial oxygen consumption] and whether low-MEE is a prognosticator of adverse cardiovascular outcome in patients with chronic inflammatory arthritis. A total of 432 outpatients with established chronic inflammatory arthritis without overt cardiac disease were recruited from March 2014-March 2016; 216 participants were used as comparison group. Low-MEE status was a priori identified by standard echocardiography at rest as less than 0.32 ml/s per g (5th percentile of MEE calculated in 145 healthy individuals). The pre-specified primary end-point of the study was a composite of cardiovascular death/hospitalization. Follow-up ended September 2019. MEE was significantly lower in chronic inflammatory arthritis patients than controls (0.35 ± 0.11 vs. 0.45 ± 0.10 ml/s per g; P < 0.001). Low-MEE was detected in 164 patients (38%). Independent predictors of low-MEE were older age, higher SBP, diabetes mellitus, LV concentric geometry and lower LV systolic function. During a follow-up of 36 (21-48) months, a primary end-point occurred in 37 patients (8.6%): 22/164 patients with low-MEE (13.4%) and 15/268 (5.6%) without low-MEE (P = 0.004). Low-MEE predicted primary end-points in multivariate Cox regression analysis [heart rate 2.23 (confidence interval 1.13-4.38), P = 0.02] together with older age, lower renal function and higher LV mass. Low-MEE is detectable in more than one-third of patients with chronic inflammatory arthritis and is associated with traditional cardiovascular risk factors and abnormalities in LV geometry and systolic function. In these patients low-MEE is a powerful prognosticator of adverse cardiovascular events.

Myocardial mechano-energetic efficiency in primary aldosteronism.

Available data indicate that patients with primary aldosteronism have an increased risk of cardiovascular events and cardiovascular risk seems to be, at least in part, independent of blood pressure (BP) values. Patients with primary aldosteronism have a greater prevalence of left ventricular (LV) hypertrophy and subtle alterations of ventricular function, which might contribute to the increase in cardiovascular risk. Recently, a noninvasive approach for the estimation of LV mechanical efficiency, obtained by echocardiography has been proposed. To evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), in a large group of patients with primary aldosteronism (n = 99) and in a control group of essential hypertensive patients (n = 99) matched for age, sex and BP values. No differences between groups for age, sex, BMI, BP values, glucose, lipid profile and renal function were observed. LV mass index was greater in primary aldosteronism vs. essential hypertensive patients (46.0 ± 16.7 vs. 36.9 ± 8.6 g/m2, P < 0.001); also relative wall thickness was greater in primary aldosteronism (0.36 ± 0.1 vs. 0.32 ± 0.4, P < 0.001). Left atrial dimensions were significantly greater in primary aldosteronism. Ejection fraction was not different between groups, while endocardial and midwall fractional shortening were lower in primary aldosteronism vs. essential hypertensive patients (40 ± 7 vs. 43 ± 6, and 18 ± 3 vs. 21 ± 2, both P < 0.01). MEEi was lower in primary aldosteronism vs. essential hypertensive patients (0.44 ± 0.14 vs. 0.52 ± 0.10 ml/s per g, P < 0.01). A negative correlation was observed between MEEi and aldosterone levels (r = -0.203, P < 0.05) and aldosterone : renin ratio (P = -0.172, P < 0.05); the correlation remained significant after adjustment for possible confounders. In patients with primary aldosteronism myocardial MEEi is lower as compared with essential hypertensive patients. A reduced MEEi may reflect an impairment of production and utilization of energy in the myocardium, which could lead to the occurrence of cardiovascular complications and therefore these findings may contribute to explain the increased risk of cardiovascular events in patients with primary aldosteronism.

Depressed Cardiac Mechanical Energetic Efficiency: A Contributor to Cardiovascular Risk in Common Metabolic Diseases-From Mechanisms to Clinical Applications.

Cardiac mechanical energetic efficiency is the ratio of external work (EW) to the total energy consumption. EW performed by the left ventricle (LV) during a single beat is represented by LV stroke work and may be calculated from the pressure–volume loop area (PVLA), while energy consumption corresponds to myocardial oxygen consumption (MVO2) expressed on a per-beat basis. Classical early human studies estimated total mechanical LV efficiency at 20–30%, whereas the remaining energy is dissipated as heat. Total mechanical efficiency is a joint effect of the efficiency of energy transfer at three sequential stages. The first step, from MVO2 to adenosine triphosphate (ATP), reflects the yield of oxidative phosphorylation (i.e., phosphate-to-oxygen ratio). The second step, from ATP split to pressure–volume area, represents the proportion of the energy liberated during ATP hydrolysis which is converted to total mechanical energy. Total mechanical energy generated per beat—represented by pressure–volume area—consists of EW (corresponding to PVLA) and potential energy, which is needed to develop tension during isovolumic contraction. The efficiency of the third step of energy transfer, i.e., from pressure–volume area to EW, decreases with depressed LV contractility, increased afterload, more concentric LV geometry with diastolic dysfunction and lower LV preload reserve. As practical assessment of LV efficiency poses methodological problems, De Simone et al. proposed a simple surrogate measure of myocardial efficiency, i.e., mechano-energetic efficiency index (MEEi) calculated from LV stroke volume, heart rate and LV mass. In two independent cohorts, including a large group of hypertensive subjects and a population-based cohort (both free of prevalent cardiovascular disease and with preserved ejection fraction), low MEEi independently predicted composite adverse cardiovascular events and incident heart failure. It was hypothesized that the prognostic ability of low MEEi can result from its association with both metabolic and hemodynamic alterations, i.e., metabolic syndrome components, the degree of insulin resistance, concentric LV geometry, LV diastolic and discrete systolic dysfunction. On the one part, an increased reliance of cardiomyocytes on the oxidation of free fatty acids, typical for insulin-resistant states, is associated with both a lower yield of ATP per oxygen molecule and lesser availability of ATP for contraction, which might decrease energetic efficiency of the first and second step of energy transfer from MVO2 to EW. On the other part, concentric LV remodeling and LV dysfunction despite preserved ejection fraction can impair the efficiency of the third energy transfer step. In conclusion, the association of low MEEi with adverse cardiovascular outcome might be related to a multi-step impairment of energy transfer from MVO2 to EW in various clinical settings, including metabolic syndrome, diabetes, hypertension and heart failure. Irrespective of theoretical considerations, MEEi appears an attractive simple tool which couldt improve risk stratification in hypertensive and diabetic patients for primary prevention purposes. Further clinical studies are warranted to estimate the predictive ability of MEEi and its post-treatment changes, especially in patients on novel antidiabetic drugs and subjects with common metabolic diseases and concomitant chronic coronary syndromes, in whom the potential relevance of MEE can be potentiated by myocardial ischemia.

Nonalcoholic fatty liver disease is associated with a decreased myocardial mechano-energetic efficiency.

Nonalcoholic fatty liver disease (NAFLD) is linked to a raised risk of cardiovascular diseases (CVD), although the underlying mechanisms are not completely known. A reduced myocardial mechano-energetic efficiency (MEE) has been found to be an independent predictor of CVD. To evaluate the association between NAFLD and a compromised MEE. Myocardial MEE was assessed by a validated echocardiography-derived measure in 699 nondiabetic individuals subdivided into two groups according to ultrasonography defined presence of NAFLD. Subjects with NAFLD displayed higher levels of systolic (SBP) and diastolic blood pressure (DBP), triglycerides, fasting and postload glucose, high-sensitivity C-reactive protein (hsCRP), insulin resistance (IR) estimated by HOMA-IR and liver IR index, and lower values of high-density lipoprotein (HDL) in comparison with those without NAFLD. Presence of NAFLD was associated with increased levels of myocardial oxygen demand and reduced values of MEE. MEE was negatively correlated with male sex, age, BMI, waist circumference, SBP, DBP, total cholesterol, triglycerides, fasting and postload glucose, HOMA-IR and liver IR index, hsCRP and positively with HDL levels. In a multivariable regression analysis, presence of NAFLD was associated with MEE regardless of several cardio-metabolic risk factors such as age, gender, waist circumference, SBP, DBP, total and HDL cholesterol, triglycerides, glucose tolerance and hsCRP (β=-0.09, P=0.04), but not independently of IR estimates. Ultrasound-defined presence of NAFLD is associated with a decreased MEE, a predictor of adverse cardiovascular events. The relationship between NAFLD and a compromised MEE is dependent of IR.

Depressed Myocardial Energetic Efficiency Increases Risk of Incident Heart Failure: The Strong Heart Study.

An estimation of myocardial mechano-energetic efficiency (MEE) per unit of left ventricular (LV) mass (MEEi) can significantly predict composite cardiovascular (CV) events in treated hypertensive patients with normal ejection fraction (EF), after adjustment for LV hypertrophy (LVH). We have tested whether MEEi predicts incident heart failure (HF), after adjustment for LVH, in the population-based cohort of a “Strong Heart Study” (SHS) with normal EF. We included 1912 SHS participants (age 59 ± 8 years; 64% women) with preserved EF (≥50%) and without prevalent CV disease. MEE was estimated as the ratio of stroke work to the “double product” of heart rate times systolic blood pressure. MEEi was calculated as MEE/LV mass, and analyzed in quartiles. During a follow-up study of 9.2 ± 2.3 years, 126 participants developed HF (7%). HF was preceded by acute myocardial infarction (AMI) in 94 participants. A Kaplan-Meier plot, in quartiles of MEEi, demonstrated significant differences, substantially due to the deviation of the lowest quartile (p < 0.0001). Using AMI as a competing risk event, sequential models of Cox regression for incident HF (including significant confounders), demonstrated that low MEEi predicted incident HF not due to AMI (p = 0.026), after adjustment for significant effect of age, LVH, prolonged LV relaxation, diabetes, and smoking habits with negligible effects for sex, hypertension, antihypertensive therapy, obesity, and hyperlipemia. Low LV mechano-energetic efficiency per unit of LVM, is a predictor of incident, non-AMI related, HF in subjects with initially normal EF.

TARGET TREATMENT OF PRIMARY ALDOSTERONISM AFFECTS CARDIAC WORK AND BIOENERGETICS

Objective: We hypothesized that hyperaldosteronism along with renin suppression can induce an energetically inefficient cardiac mechanical work in humans. Design and method: To test this hypothesis we investigated the LV mechanical efficiency by measuring myocardial mechano-energetic efficiency (MEE) and its modification after target treatment in patients with PA and essential hypertension (EH) with normal LV ejection fraction, in comparison with age-matched healthy control subjects (HS). Left ventricular (LV) dimension and systolic function, stroke volume (SV), stroke work (SW), and cardiac output (CO) were also estimated at baseline, and after adrenalectomy or medical treatment. MEE was estimated by echocardiographic SV (z-derived)/(heart rate x 0.6) and normalized for LV mass (MEEi ml/s x g). Results: We recruited 178 PA patients (age 51 ± 11 years), 78 EH patients (age 55 ± 14 years) and 60 HS (age 54 ± 11 years). At baseline, both PA and EH patients showed similarly increased LV dimension, LV mass, SV, SW and similarly reduced MEEi (PA 0.86 ± 0.2, EH 0.91 ± 0.2) compared with HS (1.07 ± 0.2, p < 0.0001). Among PA patients, those with eccentric LVH showed higher MEEi (1.06 ± 0.2 vs 0.78 ± 0.2, p < 0.0001), SV (96 ± 22 vs 81 ± 14, p < 0.0001), and CO (6.6 ± 0.1 vs 5.4 ± 0.1, p = 0.002) than those with concentric LVH. By regression analysis plasma aldosterone concentration, systolic blood pressure (BP) and body mass index (BMI) were identified as predictors of MEEi. At follow up surgically treated PA and EH showed a significant reduction of BP, LV mass and rate of LVH (PA 48% vs 69% at baseline, p = 0.001; EH 54% vs 65% at baseline, p < 0.05) and SW, and increase of arterial compliance and (not significant) of MEEi. Surgically treated PA showed also a reduction of SV (75 ± 19 vs 82 ± 16 at baseline, p < 0.0001) and CO (5.1 ± 1.4 vs 5.6 ± 1.3 at baseline, p = 0.001), not observed in medically treated PA patients. Conclusions: The lower myocardial mechano-energetic efficiency of PA patients with concentric than with eccentric LVH suggests a more detrimental effect of the former type of LV remodeling. Importantly, at follow-up LV mechano-energetic efficiency improved more in surgically-treated than in medically treated PA patients despite similar BP reductions.

Myocardial mechano-energetic efficiency and insulin resistance in non-diabetic members of the Strong Heart Study cohort

BackgroundMyocardial energetic efficiency (MEE), is a strong predictor of CV events in hypertensive patient and is reduced in patients with diabetes and metabolic syndrome. We hypothesized that severity of insulin resistance (by HOMA-IR) negatively influences MEE in participants from the Strong Heart Study (SHS).MethodsWe selected non-diabetic participants (n = 3128, 47 ± 17 years, 1807 women, 1447 obese, 870 hypertensive) free of cardiovascular (CV) disease, by merging two cohorts (Strong Heart Study and Strong Heart Family Study, age range 18–93). MEE was estimated as stroke work (SW = systolic blood pressure [SBP] × stroke volume [SV])/“double product” of SBP × heart rate (HR), as an estimate of O2 consumption, which can be simplified as SV/HR ratio and expressed in ml/sec. Due to the strong correlation, MEE was normalized by left ventricular (LV) mass (MEEi).ResultsLinear trend analyses showed that with increasing quartiles of HOMA-IR patients were older, more likely to be women, obese and hypertensive, with a trend toward a worse lipid profile (all p for trend < 0.001), progressive increase in LV mass index, stroke index and cardiac index and decline of wall mechanics (all p < 0.0001). In multivariable regression, after adjusting for confounders, and including a kinship coefficient to correct for relatedness, MEEi was negatively associated with HOMA-IR, independently of significant associations with age, sex, blood pressure, lipid profile and central obesity (all p < 0.0001).ConclusionsSeverity of insulin resistance has significant and independent negative impact on myocardial mechano-energetic efficiency in nondiabetic individual from a population study of American Indians.Trial registration number NCT00005134, Name of registry: Strong Heart Study, URL of registry: https://clinicaltrials.gov/ct2/show/NCT00005134, Date of registration: May 25, 2000, Date of enrolment of the first participant to the trial: September 1988

Inappropriate left ventricular mass after preeclampsia: another piece of the puzzle Inappropriate LVM and PE.

Excessive left ventricular (LV) mass (LVM) increase results in inefficient LV work with high energy waste and a negative prognostic effect. We aimed to investigate the presence of inappropriate LVM and to calculate the myocardial mechanoenergetic efficiency index (MEEi) in asymptomatic women with a history of early-onset (EO) or late-onset (LO) pre-eclampsia (PE). Among all women diagnosed with PE in the years 2009-2013, after applying inclusion/exclusion criteria and cost-effectiveness analysis, we randomly selected thirty women who experienced EO-PE, thirty with a previous LO-PE and thirty healthy controls to undergo echocardiography from 6 months to 4 years after delivery. Data regarding gestational age (GA) and mean uterine artery (UtA) pulsatility index (PI) at PE onset were collected from medical records. All women were free from cardiovascular risk factors. LVM excess was calculated as the ratio between observed LVM and predicted LVM (by sex, stroke work and height), while MEEi was calculated as the ratio between stroke work and "double product" (to approximate energy consumption), indexed to LVM. Concentric remodeling was present in 60% of EO-PE and 53% of LO-PE. LVM excess was significantly more often present in the EO-PE group than in the control group. LVM was inappropriate in 52% of EO-PE and 17% of LO-PE. MEEi showed a tendency towards lower values in the EO-PE group. Multivariate regression analysis showed that both LVM excess and MEEi were independently associated with lower GA and higher mean UtA PI at PE onset. Inappropriate LVM with a tendency towards reduced MEEi in the first 4 years after delivery may partially explain the elevated cardiovascular risk in former pre-eclamptic women compared to the general population.

Cardiac function, myocardial mechano-energetic efficiency, and ventricular-arterial coupling in normal pregnancy.

To assess cardiac function, myocardial mechanoenergetic efficiency (MEE), and ventricular-arterial coupling (VAC) longitudinally during normal pregnancy, and to study if there was an association between cardiac structure and function, and fetal growth. Cardiac structure and function, MEE, and ventricular-arterial coupling was assessed longitudinally in 52 healthy nulliparous women at 14, 24, and 34 weeks' gestation and 9-month postpartum. Left atrial diameter increased during pregnancy (30.41 ± 3.59 mm in the nonpregnant state and 31.02 ± 3.91, 34.06 ± 3.58, and 33.9 ± 2.97 mm in the first, second, and third trimesters, P < 0.001). Left ventricular mass increased 117.12 ± 45.0 g in the nonpregnant state and 116.5 ± 33.0, 126.9 ± 34.5, 128.4 ± 36 g in the first, second, and third trimesters (P < 0.001). Cardiac output increased from 3.4 ± 1.2 l/min to 4.3 ± 0.7 l/min in the second and third trimesters (P < 0.001). Diastolic function decreased as both E/A and e'/a' decreased during pregnancy (P < 0.05 and P < 0.001, respectively). MEE and VAC were retained during pregnancy. Heart rate was associated with birth weight centile in the first (r = 0.41, P = 0.002) and second (r = 0.46, P = 0.002) trimester. The increase in cardiac output during normal pregnancy is obtained by an increase in heart rate, followed by structural cardiac changes. The impaired systolic function is accomplished by a deteriorated diastolic function. Despite these rapid changes, the myocardium manages to work efficient with a preserved MEE. Cardiac and arterial adaption to pregnancy seems to appear parallel as evidenced by a preserved VAC.

Myocardial mechanoenergetic efficiency index (MMEI) and arterial stiffness: Association in a general population in norther Italy

A non-invasive approach for the estimation of mechanical efficiency through the calculation of the ratio between stroke work and HR-pressure product has been recently proposed by de Simone et al. This index, which expresses the amount of blood pumped in a single beat in 1 second by the heart, may be easily obtained by echocardiography. The aim of our study was to evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM) in a large general population sample in Northern Italy.Design and methodsWe evaluated 478 subjects participating in a general population study in Northern Italy (Studio Vobarno). All subjects underwent a physical examination with measurement of clinic blood pressure (BP). In all subjects laboratory examinations, 24 hours blood pressure measurement, echocardiography, and assessment of carotid-femoral pulse wave velocity (PWV) were performed.ResultsSubjects had a mean age of 58 ± 10 years, a BMI of 26 ± 4, 44% were males, 69% had arterial hypertension (55% treated). MEEi was lower in males and in patients with increased PWV. MEEi was inversely correlated with age, BMI, waist circumference, clinic and 24 hours BP, glucose, uric acid, triglycerides and directly correlated with HDL. MEEI was also inversely correlated with relative wall thickness (RWT) and PWV. At linear regression multivariate (?) analysis MEEi remained independently related to male gender (β = 0.16, p < 0.001), BMI (β = −0.13, p < 0.005), RWT (β = −0.56, p < 0.001) and PWV (β = −0.10, p < 0.05).ConclusionsIn a large sample of general population in Northern Italy myocardial mechanoenergetic efficiency was inversely correlated with arterial stiffness, independently of multiple possible confounders.

OP.7C.04] ARTERIAL STIFFNESS IS INDEPENDENTLY CORRELATED WITH MYOCARDIAL MECHANOENERGETIC EFFICIENCY IN A GENERAL POPULATION IN NORTHERN ITALY

Objective: A non-invasive approach for the estimation of mechanical efficiency through the calculation of the ratio between stroke work and HR–pressure product has been recently proposed by de Simone et al. This index, which expresses the amount of blood pumped in a single beat in 1 second by the heart, may be easily obtained by echocardiography. The aim of our study was to evaluate the determinants of myocardial mechanoenergetic efficiency index (MEEi), calculated as as stroke volume/heart rate and indexed to LV mass (MEEi = MEE/LVM) in a large general population sample in Northern Italy. Design and method: We evaluated 478 subjects participating in a general population study in Northern Italy (Studio Vobarno). All subjects underwent a physical examination with measurement of clinic blood pressure (BP). In all subjects laboratory examinations, 24 hours blood pressure measurement, echocardiography, and assessment of carotid-femoral pulse wave velocity (PWV) were performed. Results: Subjects had a mean age of 58 ± 10 years, a BMI of 26 ± 4, 44% were males, 69% had arterial hypertension (55% treated). MEEi was lower in males and in patients with increased PWV. MEEi was inversely correlated with age, BMI, waist circumference, clinic and 24 hours BP, glucose, uric acid, triglycerides and directly correlated with HDL. MEEI was also inversely correlated with relative wall thickness (RWT) and PWV. At linear regression multivariate (?) analysis MEEi remained independently related to male gender (β = 0.16, p < 0.001), BMI (β = −0.13, p < 0.005), RWT (β = −0.56, p < 0.001) and PWV (β = −0.10, p < 0.05). Conclusions: In a large sample of general population in Northern Italy myocardial mechanoenergetic efficiency was inversely correlated with arterial stiffness, independently of multiple possible confounders.

P4560Myocardial mechanoenergetic efficiency is correlated with arterial stiffness in a general population in northern Italy

P4560Myocardial mechanoenergetic efficiency is correlated with arterial stiffness in a general population in northern Italy

Effect of diabetes and metabolic syndrome on myocardial mechano-energetic efficiency in hypertensive patients. The Campania Salute Network.

Reduced myocardial mechano-energetic efficiency (MEE), estimated as stroke volume/heart rate ratio per g of left ventricular (LV) mass (LVM), and expressed in μl s−1 g−1 (MEEi), is a strong predictor of cardiovascular (CV) events, independently of LV hypertrophy and other confounders, including type II diabetes (DM). Decreased MEEi is more frequent in patients with diabetes. In the present analysis we evaluated the interrelation among MEEi, DM and metabolic syndrome (MetS) in the setting of arterial hypertension. Hypertensive patients from the Campania Salute Network, free of prevalent CV disease and with ejection fraction >50% (n=12 503), were analysed. Coexistence of MetS and DM was ordinally categorized into 4 groups: 8235 patients with neither MetS nor DM (MetS−/DM−); 502 without MetS and with DM (MetS−/DM+); 3045 with MetS and without DM (MetS+/DM−); and 721 with MetS and DM (MetS+/DM+). After controlling for sex, systolic blood pressure, body mass index, relative wall thickness (RWT), antihypertensive medications and type of antidiabetic therapy, MEEi was 333 μl s−1 g−1 in MetS−/DM−, 328 in MetS−/DM+, 326 in MetS+/DM− and 319 in MetS+/DM+ (P for trend <0.0001). In pairwise comparisons (Sidak-adjusted), all conditions, except MetS−/DM+, were significantly different from MetS−/DM− (all P<0.02). No statistical difference was detected between MetS−/DM+ and MetS+/DM−. 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+. MetS+/DM+ patients have the lowest levels of MEEi, consistent with the alterations of energy supply associated with the combination of insulin resistance with insulin deficiency.

Effect of diabetes and metabolic syndrome on myocardial mechano-energetic efficiency in hypertensive patients. The Campania Salute Network.

Reduced myocardial mechano-energetic efficiency (MEE), estimated as stroke volume/heart rate ratio per g of left ventricular (LV) mass (LVM), and expressed in μl s-1 g-1 (MEEi), is a strong predictor of cardiovascular (CV) events, independently of LV hypertrophy and other confounders, including type II diabetes (DM). Decreased MEEi is more frequent in patients with diabetes. In the present analysis we evaluated the interrelation among MEEi, DM and metabolic syndrome (MetS) in the setting of arterial hypertension. Hypertensive patients from the Campania Salute Network, free of prevalent CV disease and with ejection fraction >50% (n=12 503), were analysed. Coexistence of MetS and DM was ordinally categorized into 4 groups: 8235 patients with neither MetS nor DM (MetS-/DM-); 502 without MetS and with DM (MetS-/DM+); 3045 with MetS and without DM (MetS+/DM-); and 721 with MetS and DM (MetS+/DM+). After controlling for sex, systolic blood pressure, body mass index, relative wall thickness (RWT), antihypertensive medications and type of antidiabetic therapy, MEEi was 333 μl s-1 g-1 in MetS-/DM-, 328 in MetS-/DM+, 326 in MetS+/DM- and 319 in MetS+/DM+ (P for trend <0.0001). In pairwise comparisons (Sidak-adjusted), all conditions, except MetS-/DM+, were significantly different from MetS-/DM- (all P<0.02). No statistical difference was detected between MetS-/DM+ and MetS+/DM-. 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+. MetS+/DM+ patients have the lowest levels of MEEi, consistent with the alterations of energy supply associated with the combination of insulin resistance with insulin deficiency.