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[Cardiac performance in elderly hypertensives with left ventricular hypertrophy]
1Division of Cardiology, Tokyo Metropolitan Geriatric Hospital.
Insights
Elderly hypertensives with left ventricular hypertrophy (LVH) show impaired diastolic function and reduced cardiac reserve. Their systolic function, initially supranormal, deteriorates under stress, indicating compromised heart function.
Area of Science:
- Cardiology
- Geriatrics
- Cardiovascular Physiology
Context:
- Elderly individuals with hypertension often develop left ventricular hypertrophy (LVH).
- Assessing cardiac functional reserve is crucial for managing cardiovascular risk in this population.
- Understanding the impact of stress on cardiac function in hypertensive patients with LVH is clinically significant.
Purpose:
- To evaluate cardiac functional reserve in elderly hypertensives with and without LVH.
- To investigate the effects of isometric exercise and beta-stimulation on cardiac function in these groups.
- To compare cardiac performance under stress between hypertensive patients with LVH, without LVH, and normotensive controls.
Summary:
- Elderly hypertensives with LVH exhibited supranormal resting systolic function but impaired diastolic function.
- Isometric exercise caused a significant decrease in systolic function in the LVH group, unlike controls.
- Beta-stimulation improved systolic function in all groups, but the increment was smaller in the LVH group, suggesting reduced cardiac reserve.
Impact:
- The findings highlight impaired diastolic function and reduced cardiac reserve in elderly hypertensives with LVH.
- Systolic function deterioration under stress indicates a compromised ability to meet increased cardiac demands.
- This study underscores the need for careful monitoring and management of cardiac function in this patient group.
Abstract:
To assess the cardiac functional reserve of elderly hypertensives with left ventricular hypertrophy (LVH), we studied cardiac functions after isometric exercise and beta stimulation. Forty-two elderly hypertensives and 15 normotensives (NC group) were recruited for the study. Hypertensives were divided into 19 hypertensives with LVH (LVMI greater than 130 g/m2: H1 group) and 23 without LVH (H2 group). Echocardiographic studies were performed before and after isometric exercise (handgrip, HG) and isoproterenol administration (ISP). We measured LV mass index (LVMI), fractional shortening (FS), isovolumetric relaxation time (IRT), and the ratio of early and late diastolic transmitral flow velocity (A/E). FS at rest in the H1 group was significantly higher than in the H2 and NC groups. In the H1 group, IRT was elongated and A/E was greater than in the NC group, which indicated impaired diastolic function in the H1 group. After HG, FS in the H1 group significantly decreased while it did not change in the H2 or NC groups. FS increased in all three groups after the infusion of ISP, although the increment of FS was smaller in the H1 group. In conclusion, diastolic function was impaired whereas systolic function was supranormal at rest in the hypertrophied heart of the elderly hypertensives, and when exercise or pharmacological stress was loaded, the systolic function deteriorated, suggesting the impairment of cardiac reserve in those patients.