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Arterial pulsatile hemodynamic load induced by isometric exercise strongly predicts left ventricular mass in

Julio A Chirinos1, Patrick Segers, Amresh Raina

  • 1University of Pennsylvania, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA 19104, USA. Julio.chirinos@uphs.upenn.edu

American Journal of Physiology. Heart and Circulatory Physiology
|December 8, 2009
PubMed

Insights

Provoked hemodynamic load during isometric exercise significantly predicts left ventricular hypertrophy (LVH) in hypertensive individuals. This dynamic arterial load assessment is more advantageous than resting measurements for understanding LVH risk.

Area of Science:

  • Cardiovascular Physiology
  • Hypertension Research
  • Arterial Mechanics

Background:

  • Resting hemodynamic load is a known factor in left ventricular (LV) hypertrophy.
  • The impact of provoked hemodynamic load on LV hypertrophy risk remains less understood.

Purpose of the Study:

  • To investigate the relationship between central pressure-flow dynamics during provoked hemodynamic load and left ventricular mass index (LVMI).
  • To compare the predictive power of resting versus provoked hemodynamic load for LVMI in hypertensive adults.

Main Methods:

  • Central pressure-flow relations were assessed using carotid applanation tonometry and Doppler echocardiography in 40 hypertensive and 19 normotensive adults.
  • Measurements were taken at rest and during a 40% maximal voluntary forearm contraction (handgrip) maneuver.
  • Carotid-femoral pulse wave velocity (CF-PWV) was measured at rest.

Main Results:

  • Isometric exercise significantly altered pulsatile load, increasing systemic vascular resistance, aortic characteristic impedance (Zc), and wave reflections, while decreasing total arterial compliance (TAC).
  • Resting CF-PWV was the strongest predictor of LVMI in hypertensive subjects.
  • Provoked hemodynamic load indices, including TAC and Zc during handgrip, and changes in wave reflection timing, were independent predictors of LVMI, explaining 68% of variability.

Conclusions:

  • Hemodynamic load provoked by isometric exercise is a strong predictor of LVMI in hypertension.
  • Dynamic arterial load assessment during provoked testing captures crucial arterial properties not evident at rest.
  • Provoked testing offers advantages for assessing dynamic arterial load in hypertension and predicting LVH risk.

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