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1.
Blood Press ; 30(3): 188-195, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33769171

RESUMO

PURPOSE: The aim of this study was to examine myocardial performance using pressure-strain loops in hypertensive patients with different level of blood pressure control. MATERIAL AND METHODS: This cross-sectional study included 204 subjects (45 controls, 70 patients with well-controlled hypertension, 58 patients with uncontrolled hypertension and 31 patients with resistant hypertension) who underwent complete two-dimensional echocardiographic examination including two-dimensional speckle-tracking echocardiography. Pressure-strain curve was used to determine global myocardial work, constructive work, wasted work and work efficiency in all study participants. RESULTS: Left ventricular (LV) longitudinal strain gradually reduced from controls throughout well-controlled hypertensive patients, to patients with uncontrolled and resistant hypertension. Global myocardial work was higher in patients with uncontrolled and resistant hypertension than in controls and well-controlled hypertension. Constructive work was also higher in all hypertensive patients than in controls. Global wasted work and work efficiency were similar between different groups. Global myocardial work index was associated with peak oxygen consumption independently of sex, age, body mass index (BMI), LV structural and functional parameters in all hypertensive participants. CONCLUSIONS: Myocardial work was significantly deteriorated in patients with uncontrolled and resistant arterial hypertension compared to controls and well-controlled hypertensive patients. Global myocardial work was associated with functional capacity independent of clinical and echocardiographic parameters.


Assuntos
Ecocardiografia , Ventrículos do Coração , Hipertensão , Miocárdio , Função Ventricular Esquerda , Idoso , Estudos Transversais , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
2.
Blood Press ; 26(2): 102-108, 2017 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-27599391

RESUMO

We aimed to investigate the association between white-coat hypertension (WCH) and left atrial (LA) phasic function assessed by the volumetric and speckle tracking method. This cross-sectional study included 52 normotensive individuals, 49 subjects with WCH and 56 untreated hypertensive patients who underwent a 24-h ambulatory BP monitoring and complete two-dimensional echocardiographic examination (2DE). WCH was diagnosed if clinic blood pressure (BP) was elevated and 24-h BP was normal. We obtained that maximum, minimum LA and pre-A LAV volumes and volume indexes gradually and significantly increased from the normotensive subjects, throughout the white-coat hypertensive individuals to the hypertensive patients. Passive LA emptying fraction (EF), representing the LA conduit function, gradually reduced from normotensive to hypertensive subjects. Active LA EF and the parameter of the LA booster pump function increased in the same direction. Similar results were obtained by 2DE strain analysis. The LA stiffness index gradually increased from normotensive controls, throughout white-coat hypertensive subjects to hypertensive patients. Clinic systolic BP was associated with LA passive EF (ß= -0.283, p = 0.001), LA active EF (ß = 0.342, p < 0.001), LA total longitudinal strain (ß= -0.356, p < 0.001), LA positive longitudinal strain (ß= -0.264, p = 0.009) and LA stiffness index (ß = 0.398, p < 0.001) without regard to age, BMI, left ventricular structure and diastolic function in the whole study population. In the conclusion, WCH significantly impacts LA phasic function and stiffness. Clinic systolic BP was associated with functional and mechanical LA remodeling in the whole study population.


Assuntos
Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Ecocardiografia , Hipertensão do Jaleco Branco , Adulto , Estudos Transversais , Feminino , Átrios do Coração/diagnóstico por imagem , Átrios do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Hipertensão do Jaleco Branco/diagnóstico por imagem , Hipertensão do Jaleco Branco/fisiopatologia
3.
Blood Press ; 24(6): 361-8, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26212876

RESUMO

OBJECTIVE: We aimed to investigate left atrial (LA) phasic function in hypertensive patients with different geometric patterns using two-dimensional (2DE) and three-dimensional (3DE) echocardiography. METHODS: This cross-sectional study included 213 hypertensive subjects who underwent a complete 2DE and 3DE examination. The new updated criteria for left ventricular (LV) geometry, which consider LV mass index, LV end-diastolic diameter and relative wall thickness, were applied. According to this classification, the subjects were divided into six groups: normal geometry, concentric remodeling, eccentric non-dilated left ventricular hypertrophy (LVH), concentric LVH, dilated LVH and concentric-dilated LVH. RESULTS: 2DE and 3DE LA volumes gradually increased from normal LV geometry to concentric and concentric-dilated LVH. LA reservoir and conduit functions, estimated by 2DE and 3DE LA total and passive emptying fractions, were decreased in subjects with concentric and concentric-dilated LVH. LA booster pump function was increased in patients with concentric, dilated and concentric-dilated LVH compared to subjects with normal LV geometry. The same results regarding LA phasic function were provided by 2DE strain analysis. Concentric, dilated and non-concentric dilated LVH were associated with LA enlargement independently of main demographic and clinical features. CONCLUSION: LV geometric patterns significantly influence LA phasic function. Concentric and dilated LVH patterns have the most prominent negative effect on LA enlargement assessed by both 2DE and 3DE.


Assuntos
Função do Átrio Esquerdo , Cardiomegalia , Ventrículos do Coração , Hipertensão , Adulto , Cardiomegalia/diagnóstico por imagem , Cardiomegalia/fisiopatologia , Ecocardiografia Tridimensional , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade
4.
J Clin Hypertens (Greenwich) ; 22(11): 2121-2127, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32966690

RESUMO

We aimed to investigate myocardial performance using pressure-strain loops in hypertensive patients with and without type 2 diabetes mellitus (DM). This cross-sectional study included 165 subjects (55 controls, 60 hypertensive patients without DM, and 50 hypertensive patients with DM) who underwent complete two-dimensional echocardiographic examination (2DE) including two-dimensional speckle-tracking echocardiography. Pressure-strain curve was used to determine global myocardial work index, constructive work, wasted work, and work efficiency in all study participants. Left ventricular (LV) longitudinal and circumferential strains gradually reduced from controls throughout hypertensive subjects to patients with DM and hypertension. Global myocardial work index gradually increased from controls, throughout hypertensive patients to subjects with hypertension and DM (1887 ± 289 vs 2073 ± 311 vs 2144 ± 345 mm Hg%, P = .001). Constructive work increased in the same direction (2040 ± 319 vs 2197 ± 344 vs 2355 ± 379 mm Hg%, P < .001). Work efficiency and wasted work did not differ between three observed groups. Glycosylated hemoglobin and systolic blood pressure were associated with global myocardial work and constructive work independently of age, body mass index, LV structural and functional parameters in all hypertensive participants. In conclusion, pressure-strain curve showed that myocardial work was significantly affected by hypertension and diabetes. Diabetes demonstrated an additional negative effect on myocardial work in hypertensive patients.


Assuntos
Hipertensão , Estudos Transversais , Diabetes Mellitus Tipo 2/complicações , Ecocardiografia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Disfunção Ventricular Esquerda
5.
J Hypertens ; 38(2): 282-288, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31503137

RESUMO

OBJECTIVE: We sought to investigate left ventricular (LV) mechanics in the recently diagnosed hypertensive patients with different 24-h blood pressure (BP) patterns (dipping, nondipping, extreme dipping and reverse dipping). METHODS: The current cross-sectional study included 209 hypertensive patients who underwent 24-h ambulatory BP monitoring and comprehensive two-dimensional echocardiographic examination including multilayer strain analysis. RESULTS: There was no difference in 24-h and daytime BP values between four groups. Night-time BP significantly and gradually increased from extreme dippers, across dippers and nondippers, to reverse dippers. LV global longitudinal and circumferential strains were greater in dippers and extreme dippers than in nondippers and reverse dippers. This was also found for endocardial and epicardial LV longitudinal and circumferential strains. Multivariate logistic regression analysis demonstrated that nondipping and reverse dipping patterns were associated with reduced LV longitudinal strain [odds ratio (OR) 1.71 (95% confidence interval (CI): 1.10-5.61) and OR 2.50 (95% CI: 1.31-6.82), respectively] independently of age, sex, 24-h SBP, LV mass index and E/è. Only the reverse dipping BP pattern was independently of clinical and echocardiographic parameters related with reduced LV circumferential strain [OR 1.90 (95% CI: 1.10-4.80)]. CONCLUSION: Nondipping and reverse dipping BP patterns had stronger impact on LV mechanics compared with patients with dipping and extreme dipping BP patterns in hypertensive population. LV functional and mechanical remodeling deteriorated from extreme dippers and dippers, to nondippers and reverse dippers.


Assuntos
Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Ventrículos do Coração/fisiopatologia , Hipertensão/fisiopatologia , Adulto , Idoso , Monitorização Ambulatorial da Pressão Arterial/métodos , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
6.
Hypertens Res ; 43(3): 213-219, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31666711

RESUMO

We aimed to evaluate right ventricular (RV) deformation in recently diagnosed untreated hypertensive patients with different 24-h blood pressure (BP) patterns (dipping, nondipping, extreme dipping and reverse dipping). This cross-sectional study involved 190 untreated hypertensive patients who underwent 24-h ambulatory BP monitoring and a detailed two-dimensional echocardiographic examination, including the assessment of layer-specific strain. We found that 24-h and daytime BP values did not differ between the four groups. Nighttime BP significantly and gradually increased from extreme dippers across dippers and nondippers to reverse dippers. RV structure and systolic and diastolic function did not significantly differ among the four groups. However, RV global and RV free wall longitudinal strains were significantly lower in nondippers and reverse dippers than in dippers and extreme dippers. The endocardial and epicardial RV longitudinal strains of the whole RV and free wall RV were the lowest in reverse dippers and highest in extreme dippers. Multivariate logistic regression analysis demonstrated that only reverse dipping patterns were associated with reduced RV global longitudinal strain [OR 2.9 (95% CI: 1.5-8.2)], independent of age, sex, 24-h systolic BP, LV mass index, RV wall thickness and E/e't. Similarly, the reverse dipping pattern was associated with reduced RV free wall longitudinal strain, independently of the mentioned parameters [OR 3.8 (95% CI: 1.8-8.5)]. In conclusion, in the hypertensive population, the reverse dipping BP pattern had an adverse effect on RV deformation. RV remodeling progressively deteriorated from extreme dippers to reverse dippers, but only the reverse dipping BP pattern was independently associated with the reduction in RV longitudinal strain.


Assuntos
Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Ventrículos do Coração/fisiopatologia , Hipertensão/fisiopatologia , Remodelação Ventricular/fisiologia , Adulto , Idoso , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
7.
J Hypertens ; 38(8): 1525-1530, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32371765

RESUMO

OBJECTIVE: We sought to investigate the predictive value of right ventricular (RV) remodeling and 24-h blood pressure (BP) patterns on long-term cardiovascular prognosis in the initially untreated hypertensive patients. METHODS: The current study included 505 initially untreated hypertensive patients who were consequently included in this study from 2007 to 2012. All the patients underwent laboratory analysis, 24-h BP monitoring and echocardiographic examination at baseline. The patients were followed for a median period of 9 years. The adverse outcome was defined as the hospitalization due to cardiovascular events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or cardiovascular death). RESULTS: During the 9-year follow-up period adverse cardiovascular events occurred in 82 hypertensive patients. Night-time SBP, the nondipping BP pattern, left ventricle hypertrophy, RV hypertrophy, right atrial enlargement, RV diastolic dysfunction, and RV systolic dysfunction were associated with adverse cardiovascular events. Nevertheless, night-time SBP, the nondipping BP pattern, mitral E/e', left ventricle hypertrophy, and RV hypertrophy were the only independent predictors of cardiovascular events. When all four BP patterns were included in the model, only the reverse dipping BP pattern was an independent predictor of cardiovascular events. CONCLUSION: The present investigation showed that RV hypertrophy and the reverse dipping BP pattern were independent long-term predictors of the cardiovascular outcome. Detailed echocardiographic evaluation and 24-h ambulatory blood pressure monitoring should be performed even in low-risk hypertensive patients.


Assuntos
Pressão Sanguínea/fisiologia , Doenças Cardiovasculares , Ritmo Circadiano/fisiologia , Hipertensão , Remodelação Ventricular/fisiologia , Adulto , Idoso , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/fisiopatologia , Feminino , Seguimentos , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Prognóstico
8.
J Hypertens ; 38(11): 2245-2251, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32649632

RESUMO

OBJECTIVE: We aimed to investigate left atrial phasic function in the recently diagnosed hypertensive patients and determine association between circadian blood pressure (BP) patterns and left atrial function. METHODS: The present study involved 256 untreated hypertensive patients who underwent 24-h ambulatory BP monitoring and comprehensive echocardiographic examination. All patients were divided into four groups according to the percentage of nocturnal BP drop (dippers, extreme dippers, nondippers and reverse dippers). RESULTS: There was no significant difference in daytime BPs between the observed groups, whereas night-time BPs significantly and gradually increased from extreme dippers and dippers, across nondippers, to reverse dippers. Total, passive and active left atrial emptying fractions that correspond with left atrial reservoir, conduit and contractile function were lower in nondippers and reverse dippers than in dippers and extreme dippers. Reservoir and contractile left atrial strains were lower in reverse dippers than in dippers and extreme dippers, whereas conduit left atrial strain was lower in reverse dippers in comparison with extreme dippers. Nondipping and reverse dipping BP patterns were, independently of age, sex, nocturnal BPs, left ventricular mass index, E/e', associated with reduced reservoir function. Nevertheless, only reverse dipping profile was independently of other circadian BP profiles, nocturnal BP, demographic and echocardiographic parameters related with reduced conduit and contractile functions. CONCLUSION: Nondipping and reverse dipping BP patterns were related with impaired left atrial phasic function. However, reverse pattern was the only circadian profile that was independently of other clinical parameters, including night-time BP, associated with decreased reservoir, conduit and contractile function.


Assuntos
Função do Átrio Esquerdo/fisiologia , Átrios do Coração/fisiopatologia , Hipertensão/fisiopatologia , Pressão Sanguínea/fisiologia , Ecocardiografia , Humanos
9.
Hypertens Res ; 42(8): 1200-1208, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30944414

RESUMO

The purpose of this investigation was to evaluate the influence of hypertension on left atrial (LA) function in patients with moderate and severe AS. This cross-sectional study included 121 patients with moderate and severe AS and preserved left ventricular (LV) ejection fraction ( > 50%) and 79 age-matched controls who underwent a comprehensive echocardiographic examination. LA phasic function was determined by both volumetric and strain methods. Our findings showed that the LV ejection fraction was similar between hypertensive and normotensive AS patients. Maximal, minimal, and pre-A LA volume indexes gradually increased from controls to moderate-to-severe AS patients. The total, passive and active LA emptying fraction (EF) gradually decreased in the same direction. LA phasic function estimated with strain analysis showed that reservoir, conduit, and pump LA phasic functions were lower in all AS patients than in normotensive controls. However, there was no significant difference between moderate and severe AS except in LA pump function, which was lower in severe AS. Differences in LA phasic function were more prominent in volumetric than in strain analyses. Blood pressure, LV mass index, and AS severity were independent of other clinical and echocardiographic parameters associated with LA phasic function in patients with AS. In conclusion, hypertension has an additive impact on LA phasic function in patients with moderate and severe AS. Blood pressure and AS severity were independently associated with LA phasic function parameters in AS patients. Volumetric assessment of LA phasic function should not be completely replaced with strain analysis.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Função do Átrio Esquerdo , Hipertensão/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Estudos de Casos e Controles , Estudos Transversais , Ecocardiografia , Feminino , Átrios do Coração/fisiopatologia , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Gravidez
10.
J Clin Hypertens (Greenwich) ; 21(4): 516-523, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30834672

RESUMO

The purpose of this investigation was to evaluate the influence of aortic stenosis (AS) on right ventricular (RV) strain and particularly the importance of arterial hypertension on this association. This cross-sectional study included 107 patients with moderate and severe AS (with and without hypertension) and preserved left ventricular ejection fraction (>50%) and 82 age-matched normotensive and hypertensive controls who underwent comprehensive echocardiographic examination. AS patients were divided into normotensive and hypertensive groups. Left ventricle (LV) mass index gradually increased from the controls, across the moderate AS to the severe AS. There was a trend of reduction of RV global and layer-specific longitudinal strain of the whole ventricle and RV free wall from the controls, across the moderate AS to the severe AS. RV global longitudinal strain, as well as layer-specific RV longitudinal strains, was significantly lower in the patients with severe AS than the controls and the normotensive patients with moderate AS. Endocardial and epicardial RV strains were lower in hypertensive than in normotensive patients with moderate AS. In patients with severe AS, there was no difference between normotensive and hypertensive patients. LV mass index and mean aortic valve gradient were associated with RV global longitudinal strain in AS patients independently of systolic blood pressure, LV ejection fraction (EF), age, and body mass index (BMI). In conclusion, RV mechanics was deteriorated in the patients with moderate and severe AS. There was a trend of RV longitudinal strain worsening in the hypertensive patients with AS in comparison with their normotensive counterparts. Severity of AS, expressed by the mean AV gradient, was related with RV longitudinal strain.


Assuntos
Estenose da Valva Aórtica/complicações , Ventrículos do Coração/diagnóstico por imagem , Hipertensão/fisiopatologia , Função Ventricular Direita/fisiologia , Idoso , Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/mortalidade , Pressão Sanguínea/fisiologia , Estudos de Casos e Controles , Estudos Transversais , Ecocardiografia/métodos , Feminino , Ventrículos do Coração/fisiopatologia , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Valor Preditivo dos Testes , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia
11.
J Hypertens ; 37(4): 747-753, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30817456

RESUMO

OBJECTIVE: The influence of arterial hypertension on aortic stenosis severity is still controversial. The aim of this study was to evaluate the influence of hypertension on LV strain in patients with moderate and severe aortic stenosis. METHODS: This cross-sectional study included 115 patients with moderate and severe aortic stenosis and preserved LV ejection fraction (>50%) and 89 age-matched normotensive and hypertensive controls who underwent comprehensive echocardiographic examination. Aortic stenosis patients were divided into normotensive and hypertensive groups. RESULTS: There was no significant difference in LV ejection fraction between hypertensive and normotensive aortic stenosis patients. LV mass index gradually increased with the grade of aortic stenosis. LV global longitudinal strain, as well as endocardial and epicardial longitudinal strains, was significantly lower in hypertensive patients with severe aortic stenosis than in their normotensive counterparts. There was no significant difference in LV global circumferential strain between normotensive and hypertensive patients with severe aortic stenosis. Among patients with moderate aortic stenosis, there was no difference in global longitudinal strain between normotensives and hypertensive patients, whereas circumferential was significantly lower in hypertensive patients. LV radial strain was reduced in patients with severe aortic stenosis than in control subjects. SBP and mean aortic valve gradient were associated with LV global longitudinal and circumferential strains in aortic stenosis patients independently of LV mass index, LVEF, age and BMI. CONCLUSION: Hypertension had additional significant negative influence on LV mechanics in patients with significant aortic stenosis. Blood pressure was associated with LV global longitudinal and circumferential strains in aortic stenosis patients independently of main clinical and demographic characteristics.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Hipertensão/fisiopatologia , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia , Idoso , Estenose da Valva Aórtica/diagnóstico por imagem , Pressão Sanguínea , Estudos Transversais , Ecocardiografia , Feminino , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Volume Sistólico/fisiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem
12.
J Hypertens ; 37(1): 50-56, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-29878974

RESUMO

OBJECTIVE: The aim of this study was to evaluate the influence of sex on left ventricular mechanics in hypertensive individuals. METHODS: This cross-sectional study included 171 untreated hypertensive patients and 112 normotensive controls who underwent a 24-h ambulatory blood pressure monitoring and comprehensive echocardiographic examination including strain assessment. RESULTS: Hypertensive women and men had significantly lower left ventricular global longitudinal and circumferential strains than their normotensive counterparts. Left ventricular global longitudinal strain was lower in hypertensive men than in women (-19.8 ±â€Š2.2 vs. -17.9 ±â€Š2.1%; P < 0.01). Left ventricular global circumferential strain was also reduced in hypertensive men in comparison with women (-21.0 ±â€Š2.5 vs. -18.7 ±â€Š2.3%; P < 0.01). The difference in left ventricular radial strain was not discovered between hypertensive women and men. Furthermore, left ventricular twist was significantly higher in hypertensive women than in hypertensive men (21.9 ±â€Š4.1° vs. 20.6 ±â€Š3.8°; P = 0.034). Female sex and arterial hypertension, and also their interaction, were associated with lower left ventricular mass index, increased left ventricular global longitudinal, and circumferential strains and increased left ventricular twist compared with hypertensive men. CONCLUSION: Left ventricular longitudinal and circumferential strains were significantly reduced in hypertensive patients. However, the changes are more pronounced in hypertensive men than in women. Sex has a significant effect on the association between hypertension, and longitudinal and circumferential strain.


Assuntos
Ventrículos do Coração/fisiopatologia , Hipertensão , Pressão Sanguínea/fisiologia , Monitorização Ambulatorial da Pressão Arterial , Estudos Transversais , Ecocardiografia , Feminino , Humanos , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino
13.
J Clin Med ; 8(12)2019 Dec 02.
Artigo em Inglês | MEDLINE | ID: mdl-31810363

RESUMO

We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population.

14.
J Clin Hypertens (Greenwich) ; 20(9): 1327-1333, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29984913

RESUMO

The importance of right ventricular (RV) structure and function in cardiovascular and total morbidity and mortality has been confirmed previously. The purpose of this study was to evaluate the influence of gender on RV structure and function in untreated hypertensive patients. This cross-sectional study included 243 subjects who underwent 24-hour ambulatory blood pressure (BP) monitoring and comprehensive echocardiographic examination including strain evaluation. There was no difference in RV diameter between hypertensive and normotensive women and men. RV wall thickness, right atrial volume index (RAVI), and tricuspid E/e' ratio were significantly higher in hypertensive women and men than in their normotensive counterparts. RV global longitudinal and RV free wall longitudinal strains were significantly lower in hypertensive women and men than in their normotensive counterparts. Arterial hypertension affected RV wall thickness, RAVI, tricuspid E/e', and RV longitudinal strain. Gender affected RV diameter, RAVI, tricuspid E/e', and RV longitudinal strain, whereas hypertension-gender interaction affected RAVI, E/e', and RV longitudinal strain. The 24-hour systolic BP and LV mass index were independently associated with RV free wall longitudinal strain. RV wall thickness was independently associated with RV free wall longitudinal strain only in women, and tricuspid E/e' was independently associated only in men. In conclusion, RV longitudinal strain was significantly decreased in hypertensive patients in both sexes. Hypertensive men suffered more evident RV mechanical changes than hypertensive women. Gender, arterial hypertension, and their interaction had the important role in RV structural and mechanical remodeling.


Assuntos
Ventrículos do Coração/patologia , Hipertensão , Disfunção Ventricular Direita , Adulto , Monitorização Ambulatorial da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial/estatística & dados numéricos , Ecocardiografia/métodos , Feminino , Humanos , Hipertensão/complicações , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Tamanho do Órgão , Sérvia/epidemiologia , Fatores Sexuais , Disfunção Ventricular Direita/diagnóstico , Disfunção Ventricular Direita/epidemiologia , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita
15.
Cardiology ; 108(1): 62-70, 2007.
Artigo em Inglês | MEDLINE | ID: mdl-17003543

RESUMO

BACKGROUND: Left ventricular diastolic dysfunction and oxidative stress are important determinants in heart failure development. Peak oxygen uptake, maximal oxygen consumption, metabolic equivalents (MET), ventilatory response and time to respiratory gas exchange assess cardiopulmonary capacity. AIM: It was the aim of this study to investigate the impact of oxidative stress on diastolic indexes and cardiopulmonary exercise capacity in hypertensive patients with left ventricular diastolic dysfunction. METHODS: Mitral flow velocities (E, A), ejection fraction, left atrial and ventricular diameters were assessed by Doppler echocardiography. Superoxide dismutase (SOD) and glutathione peroxidase activity in blood were evaluated. Sixty patients (aged 49.8 +/- 9.2 years) with essential hypertension and preserved systolic function (ejection fraction 58.3 +/- 7%) performed a bicycle exercise test. Forty patients showed impaired left ventricular relaxation (E/A <1, deceleration time of E >220 ms) and were assigned to group 1, while 20 had normal relaxation (group 2). RESULTS: An increase in SOD was significantly blunted after exercise in group 1 compared with group 2 (p = 0.049). A significant difference between groups in the glutathione peroxidase level was observed before exercise (p = 0.038). There were significantly lower values of peak oxygen uptake and MET (p = 0.013 and p = 0.024, respectively) and a prolonged respiratory exchange ratio (p = 0.022) in group 1 compared with group 2. MET was significantly influenced by SOD level (p = 0.035). CONCLUSIONS: Lower antioxidative protection and impaired relaxation decrease cardiopulmonary capacity in hypertensive patients.


Assuntos
Tolerância ao Exercício/fisiologia , Hipertensão/diagnóstico , Estresse Oxidativo/fisiologia , Disfunção Ventricular Esquerda/etiologia , Idoso , Estudos de Coortes , Diástole , Ecocardiografia Doppler , Teste de Esforço , Feminino , Seguimentos , Humanos , Hipertensão/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio/fisiologia , Probabilidade , Medição de Risco , Índice de Gravidade de Doença , Volume Sistólico , Disfunção Ventricular Esquerda/fisiopatologia , Função Ventricular Esquerda/fisiologia
16.
Eur Heart J Acute Cardiovasc Care ; 6(8): 676-684, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25943556

RESUMO

AIMS: To examine the prognostic value of admission (A) and discharge (D) haemoglobin (Hb) and its relationship with N-terminal pro-hormone B-type natriuretic peptide (NT-proBNP) in patients hospitalised for acute heart failure (AHF). The outcomes of interests were rehospitalisation or death after one, six or twelve months after discharge. METHODS: 317 hospitalised AHF patients (74.7±9.4 years) were enrolled in two academic centres in Belgrade and Rome. Laboratory analyses, including NT-proBNP were assessed at admission, and Hb also at discharge. Patients were divided into two groups according to the presence of anaemia. Follow-up contact was made by telephone. Statistical analyses were performed using SPSS software version 21.0. RESULTS: According to A and DHb levels (<120 g/l for women and <130 g/l for men), anaemia was present in 55% and 62% of patients, respectively ( P=0.497). Lower DHb was associated with the rehospitalisation risk after one (OR=0.96, P=0.004), six (OR=0.97, P<0.001) and 12 months (OR=0.97, P<0.001). For every g/l decrease of DHb, the risk of rehospitalisation after one year was increased by 3.3%. In the first six months, DHb contributed to increased risk of death (OR=0.97, P=0.005), but NT-proBNP showed greater power (OR=2.1, P<0.001). CONCLUSIONS: In AHF patients discharge anaemia is a strong predictor for short and long-term rehospitalisation, while NT-proBNP seems to be a better predictor for mortality. Discharge Hb and NT-proBNP should be assessed together in order to detect the patients with higher risk of future death and rehospitalisation.


Assuntos
Anemia/etiologia , Insuficiência Cardíaca/sangue , Hemoglobinas/metabolismo , Peptídeo Natriurético Encefálico/sangue , Fragmentos de Peptídeos/sangue , Medição de Risco , Doença Aguda , Idoso , Anemia/sangue , Anemia/epidemiologia , Biomarcadores/sangue , Causas de Morte/tendências , Progressão da Doença , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/mortalidade , Humanos , Incidência , Itália/epidemiologia , Masculino , Alta do Paciente/tendências , Readmissão do Paciente/tendências , Prognóstico , Precursores de Proteínas , Curva ROC , Sérvia/epidemiologia , Taxa de Sobrevida/tendências
17.
J Hypertens ; 34(4): 772-80, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26825168

RESUMO

OBJECTIVE: The aim of this study was to determine the relationship between blood pressure (BP) variability and left ventricular (LV) mechanical function in untreated normal-weight, overweight, and obese hypertensive patients. METHODS: This cross-sectional study included 144 untreated hypertensive study participants who underwent 24-h ambulatory BP monitoring and complete two (2DE) and three-dimensional echocardiography (3DE). All the patients were divided into three groups according to their BMI: normal-weight patients (BMI < 25 kg/m), overweight patients (25 ≤ BMI < 30 kg/m), and obese patients (BMI ≥ 30 kg/m). RESULTS: Daytime, night-time, and 24-h BP variability progressively increased from normal-weight, throughout overweight, to obese hypertensive study participants. 2DE and 3DE LV longitudinal, circumferential and radial strains, as well as 3DE area strain, were significantly lower in obese hypertensive patients than in normal-weight and overweight study participants. 3DE LV volumes indexed for BSA did not differ significantly among the three observed groups. Night-time and 24 h BP variability indices, more than daytime BP variability parameters, were associated with 2DE and 3DE longitudinal and circumferential strains independent of BMI, LV mass index, and average 24-h SBP and DBP values. CONCLUSION: BP variability and LV deformation are significantly affected by obesity in untreated hypertensive patients. BP variability is associated with 2DE and 3DE LV mechanics independently of main clinical and echocardiographic characteristics.


Assuntos
Pressão Sanguínea/fisiologia , Hipertensão/fisiopatologia , Obesidade/fisiopatologia , Função Ventricular Esquerda/fisiologia , Adulto , Estudos Transversais , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia
18.
J Hypertens ; 33(5): 1090-7, 2015 May.
Artigo em Inglês | MEDLINE | ID: mdl-25668353

RESUMO

OBJECTIVE: We aimed at evaluating right ventricular remodeling (structure, function, and mechanics) and heart rate variability (HRV), as well as their interaction, in untreated hypertensive patients. METHOD: This cross-sectional study involved 55 untreated hypertensive patients and 40 patients with no risk factors, similar by sex and age. All the patients underwent a 24-h Holter monitoring and comprehensive two-dimensional and three-dimensional echocardiography assessment (2DE and 3DE). RESULTS: All time and frequency domain HRV variables were reduced in the hypertensive patients. Right ventricular systolic and diastolic function, as well as right ventricular longitudinal strain, was significantly impaired in the hypertensive patients. Parameters that indicate comprehensive right ventricular remodeling (right ventricular wall thickness, tricuspid E/e' ratio, 2DE right ventricular longitudinal strain, and 3D right ventricular ejection fraction) correlated with the parameters of cardiac sympathovagal balance (SD of all normal RR intervals, root mean square of the difference between the coupling intervals of adjacent RR intervals, 24-h low-frequency domain, 24-h high-frequency domain, and 24-h total power). Of note, right ventricular diastolic function, right ventricular longitudinal function, and 3DE right ventricular ejection fraction were associated with cardiac autonomic nervous function, independently of age, BMI, blood pressure, and left ventricular hypertrophy. CONCLUSIONS: Right ventricular structure, systolic and diastolic function, as well as right ventricular longitudinal deformation, are significantly impaired in untreated hypertensive patients. HRV variables are also decreased in hypertensive population. 2DE and 3DE parameters resembling right ventricular remodeling are independently associated with cardiac autonomic nervous system markers in the whole study population.


Assuntos
Frequência Cardíaca/fisiologia , Ventrículos do Coração/fisiopatologia , Hipertensão/fisiopatologia , Função Ventricular Direita , Remodelação Ventricular , Idoso , Pressão Sanguínea , Estudos Transversais , Diástole , Ecocardiografia , Ecocardiografia Tridimensional , Eletrocardiografia Ambulatorial , Feminino , Coração/fisiopatologia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Hipertensão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Sístole
19.
J Clin Hypertens (Greenwich) ; 17(2): 118-25, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25496306

RESUMO

The authors sought to investigate left ventricular (LV) mechanics and heart rate variability (HRV), and their relationship, in untreated hypertensive patients. A total of 63 untreated hypertensive patients and 45 healthy patients were included. All patients underwent 24-hour Holter monitoring and echocardiographic examination (two- and three-dimensional). All parameters of time and frequency domain of HRV were decreased in the hypertensive patients. Two-dimensional LV longitudinal and circumferential deformation was significantly reduced in hypertensive patients. Three-dimensional LV strain in all three directions as well as area strain were reduced in the hypertensive group. In two different models of multivariate regression, two-dimensional LV longitudinal and circumferential strain, as well as three-dimensional LV area strain, remained associated with HRV parameters independently of LV structural and functional parameters. This study showed that LV mechanics and HRV were significantly impaired in untreated hypertensive patients. Two- and three-dimensional echocardiographic LV deformation were independently associated with HRV parameters in the whole study population.


Assuntos
Pressão Sanguínea/fisiologia , Ritmo Circadiano/fisiologia , Frequência Cardíaca/fisiologia , Hipertensão/fisiopatologia , Função Ventricular Esquerda/fisiologia , Adulto , Estudos de Casos e Controles , Estudos Transversais , Ecocardiografia , Ecocardiografia Tridimensional , Eletrocardiografia Ambulatorial , Feminino , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão
20.
J Am Soc Echocardiogr ; 28(3): 317-27, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25560484

RESUMO

BACKGROUND: The aim of this study was to determine right ventricular (RV) and right atrial (RA) deformation assessed by two-dimensional echocardiographic and three-dimensional echocardiographic (3DE) imaging in patients with prediabetes and type 2 diabetes mellitus. METHODS: This cross-sectional study included 47 untreated normotensive subjects with prediabetes, 57 recently diagnosed normotensive patients with diabetes, and 54 healthy controls of similar sex and age distributions. All subjects underwent laboratory analyses and complete two-dimensional echocardiographic and 3DE examinations. RESULTS: Three-dimensional echocardiographic RV end-diastolic volume index gradually decreased from controls across patients with diabetes to those with diabetes (69 ± 10 vs 63 ± 8 vs 58 ± 8 mL/m(2), P < .001), whereas 3DE RV end-systolic volume index was higher in controls compared with patients with diabetes and those with diabetes (25 ± 4 vs 23 ± 4 vs 22 ± 4 mL/m(2), P < .001). However, there was no difference in 3DE RV ejection fraction among the three groups (63 ± 4% vs 62 ± 4% vs 61 ± 5%, P = .063). RV and RA global strain and systolic and early diastolic strain rates were decreased in patients with prediabetes and in those with diabetes compared with controls, whereas RV and RA late diastolic strain rates were increased in these patients. Multivariate regression analysis showed that RV global strain was associated with glycated hemoglobin, independent of left ventricular parameters. CONCLUSIONS: RV and RA myocardial deformation and function obtained by 3DE and two-dimensional echocardiographic strain, even in normal ranges, were decreased in patients with prediabetes and in those with diabetes compared with controls. The long-term parameter of glucose control was correlated with the right heart mechanics.


Assuntos
Diabetes Mellitus Tipo 2/fisiopatologia , Ecocardiografia Tridimensional/métodos , Técnicas de Imagem por Elasticidade/métodos , Estado Pré-Diabético/fisiopatologia , Disfunção Ventricular Direita/diagnóstico por imagem , Disfunção Ventricular Direita/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/diagnóstico por imagem , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Estado Pré-Diabético/complicações , Estado Pré-Diabético/diagnóstico por imagem , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Volume Sistólico , Disfunção Ventricular Direita/etiologia
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