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Cardiac performance in elderly hypertensive patients with left ventricular hypertrophy: responses to isometric
Y Suzuki1, I Kuwajima, S Hoshino
1Division of Cardiology, Tokyo Metropolitan Geriatric Hospital, Japan.
Insights
Elderly hypertensive patients with left ventricular hypertrophy have impaired diastolic function and reduced cardiac reserve. Their systolic function deteriorates under stress, unlike those without hypertrophy.
Area of Science:
- Cardiology
- Geriatrics
- Hypertension Research
Background:
- Elderly hypertensive patients often develop left ventricular hypertrophy (LVH).
- Assessing cardiac functional reserve is crucial for managing cardiovascular risk in this population.
Purpose of the Study:
- To evaluate the cardiac functional reserve in elderly hypertensive patients with and without LVH.
- To investigate the impact of isometric exercise and beta-adrenergic stimulation on cardiac function.
Main Methods:
- Echocardiography was used to assess cardiac function in 45 hypertensive patients and 16 controls.
- Hypertensive patients were stratified into groups with (H1) and without (H2) LVH.
- Cardiac function was measured at rest, after isometric handgrip exercise, and after isoproterenol infusion.
Main Results:
- Patients with LVH (H1 group) showed supranormal systolic function (FS) at rest but impaired diastolic function (IRT, A/E ratio).
- Isometric exercise significantly decreased FS in the H1 group, while H2 and NC groups showed no change.
- Isoproterenol increased FS in all groups, but the increment was smaller in the H1 group.
Conclusions:
- Elderly hypertensive patients with LVH exhibit impaired diastolic function and supranormal resting systolic function.
- Cardiac reserve is compromised in these patients, as evidenced by systolic function deterioration under stress.
Abstract:
To assess the cardiac functional reserve of elderly hypertensive patients with left ventricular hypertrophy (LVH) we studied cardiac function after isometric exercise and beta-adrenergic stimulation. Forty-five elderly hypertensive and 16 normotensive patients (NC group) were recruited for the study. The hypertensive patients were divided into two groups: those with LVH (n = 17) mass index (LV mass index greater than 130 g/m2; H1 group) and those without LVH (n = 28) (H2 group). Echocardiographic studies were performed before and after isometric exercise (handgrip) and isoproterenol (ISP) administration. We measured the LV mass index, fractional shortening (FS), isovolumic relaxation time (IRT), and the ratio of late and early diastolic transmitral flow velocity (A/E). The FS at rest in the H1 group was significantly higher than those in the H2 and NC groups. In the H1 group, the IRT was elongated and A/E was greater than in the NC group, which indicated the impaired diastolic function in the H1 group. After the HG stress, the FS in the H1 group significantly decreased whereas it did not change in the H2 or NC groups. The FS increased in all three groups after the infusion of ISP, although the increment of FS was smaller in the H1 group. In conclusion, (a) diastolic function was impaired whereas systolic function was supranormal at rest in the hypertrophied heart of the elderly hypertensive patients and (b) when exercise or pharmacological stress was loaded, the systolic function deteriorated, suggesting the impairment of cardiac reserve in those patients.