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[Hypertensive cardiopathy. Functional evaluation during isometric effort after regression of left ventricular
J B Nogueira1, A Freitas, C Morais
1Centro de Cardiologia, Universidade de Lisboa, INIC.
Insights
Isometric exercise reveals hidden heart function changes in hypertension. Normalizing left ventricular hypertrophy improves cardiac function, highlighting the importance of complete regression.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Hypertension Research
Context:
- Hypertension often leads to left ventricular hypertrophy (LVH).
- The functional impact of LVH regression in hypertensive patients is not fully understood.
- Isometric exercise is a valuable tool for assessing cardiac reserve.
Purpose:
- To evaluate the echocardiographic response to isometric exercise in hypertensive patients with and without LVH.
- To compare cardiac function and hemodynamics between patients with persistent LVH, normalized LVH, and healthy controls during exercise.
Summary:
- Isometric exercise testing in hypertensive patients revealed functional alterations not apparent at rest.
- Patients with normalized left ventricular hypertrophy (Group B) showed improved cardiac index and contractility index compared to those with persistent LVH (Group A).
- Hypertensive patients with persistent LVH exhibited a greater increase in end-systolic stress and peripheral resistance.
Impact:
- Isometric exercise can unmask subclinical cardiac dysfunction in hypertension.
- Regression of left ventricular hypertrophy is associated with improved cardiac function and inotropic reserve.
- These findings underscore the clinical significance of achieving complete regression of ventricular hypertrophy in managing hypertensive heart disease.
Objective:
Echocardiographic evaluation of the response to isometric exercise of hypertensive patients with and without left ventricular hypertrophy.
Participants:
28 patients with severe arterial hypertension on long-term follow-up with or without regression of left ventricular hypertrophy on medical therapy; a control group of 10 healthy volunteers.
Methods:
Two groups were considered: Group A persistent left ventricular hypertrophy and group B normalization of the left ventricular wall thickness and mass index. The arterial blood pressure and heart rate were evaluated and an echocardiographic record was obtained both at rest and after isometric exercise (maximal effort for 1 to 1.5 minutes). The following echocardiographic data were obtained: left ventricular diameters and thickness of septum and posterior wall during systole and diastole. Volumes, shortening and ejection fractions, cardiac output and index, mass index, end-systolic stress, contractility index and periferal resistance were calculated as usual.
Results:
During isometric exercise there was a rise in systolic, diastolic and mean arterial pressures and heart rate. Systolic function was normal in all groups at rest. The shortening fraction was not altered in normotensive individuals with isometric exercise. Hypertensive patients showed a significant reduction within normal limits, however. End-systolic stress increased significantly in all groups although the rise was greater in hypertensive patients. The cardiac index rose significantly only in normotensives and hypertensive patients without left ventricular hypertrophy (group B). On the contrary the periferal resistance rose significantly only in hypertensive patients with left ventricular hypertrophy (group A). The contractility index (end-systolic stress/end-systolic volume index) increased significantly only in normotensive and hypertensive patients without left ventricular hypertrophy.
Conclusions:
There are functional alterations in hypertensive heart disease which although not evident at rest, can be revealed by isometric exercise. The regression of left ventricular hypertrophy back to normal, sets a trend for normalization of function and cardiac inotropic reserve, suggesting the importance of a complete regression of ventricular hypertrophy.