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Left Ventricular Function Assessed by One-Point Carotid Wave Intensity in Newly Diagnosed Untreated Hypertensive
Olga Vriz1, Serena Favretto2, Joanna Jaroch3
1Department of Cardiology and Emergency Medicine, Sant'Antonio Hospital, San Daniele del Friuli, Udine, Italy.
Insights
Newly diagnosed hypertensive patients exhibit increased left ventricular (LV) contractility and carotid wave intensity (WI) parameters compared to normotensive individuals. This study highlights early signs of cardiac changes in hypertension.
Area of Science:
- Cardiovascular Physiology
- Hypertension Research
- Echocardiography and Hemodynamics
Background:
- Hypertension is a major risk factor for cardiovascular disease, often associated with cardiac remodeling.
- Early detection of changes in left ventricular (LV) function is crucial for managing hypertension.
- Traditional echocardiographic indices and novel hemodynamic parameters like carotid wave intensity (WI) may reveal subclinical cardiac alterations.
Purpose of the Study:
- To determine if newly diagnosed, untreated hypertensive patients display enhanced LV contractility.
- To assess LV contractility using both standard echocardiographic measures and carotid wave intensity (WI) parameters.
- To investigate specific WI parameters, including the amplitudes of early (W1) and late systolic (W2) peaks.
Main Methods:
- A cohort of 145 untreated hypertensive patients was compared with 145 age- and sex-matched normotensive controls.
- Comprehensive echocardiography and carotid artery wave intensity (WI) analysis were performed.
- WI was calculated as (dP/dt)×(dU/dt), with pulse wave velocity (PWVβ) and R-W1 interval also derived using an echo-tracking system.
Main Results:
- Hypertensive patients showed significantly higher LV mass, LV ejection fraction (LVEF), and LV end-systolic stress compared to controls.
- Carotid WI parameters, specifically W1 and W2 amplitudes, were significantly elevated in hypertensive individuals.
- Higher LVEF tertiles in hypertensives correlated with increased W1, relative wall thickness, fractional shortening, and R-W1 interval.
Conclusions:
- Newly diagnosed hypertensive patients demonstrate increased left ventricular mass and contractility.
- Carotid wave intensity parameters (W1, W2) and the R-W1 interval are elevated in early hypertension.
- No significant differences in LV diastolic function were observed between hypertensive and normotensive groups.
Objectives:
To investigate whether newly diagnosed untreated hypertensive patients show higher left ventricular (LV) contractility, as assessed by traditional echocardiographic indices and carotid wave intensity (WI) parameters, including amplitude of the peak during early (W1 ) and late systole (W2 ).
Methods:
A total of 145 untreated hypertensive patients were compared with 145 age- and sex-matched normotensive subjects. They underwent comprehensive echocardiography and WI analysis. WI analysis was performed at the level of the common carotid artery. The diameter changes were the difference between the displacement of the anterior and posterior walls, with the cursors set to track the media-adventitia boundaries 2 cm proximal to the carotid bulb and calibrated by systolic and diastolic BP. Peak acceleration was derived from blood flow velocity measured by Doppler sonography with the range-gate positioned at the center of the vessel diameter. WI was based on the calculation of (dP/dt)×(dU/dt), where dP/dt and dU/dt were the derivatives of BP (P) and velocity (U) with respect to time. One-point pulse wave velocity (PWVβ) and the interval between the R wave on ECG and the first peak of WI (R-W1 ), using a high definition echo-tracking system implemented in the ultrasound machine (Aloka), were also derived.
Results:
After adjustment for body weight, heart rate, and physical activity, the two groups had similar general characteristics and diastolic function. However, hypertensives showed significantly higher LV mass, LV ejection fraction (LVEF), circumferential and LV end-systolic stress, and one-point PWV as well as W1 (13.646 ± 7.368 vs 9.308 ± 4.675 mmHg m/s3 , P =.001) and W2 (4.289 ± 2.017 vs 2.995 ± 1.868 mmHg m/s3 , P =.001). Hypertensives were divided into tertiles according to LVEF: W1 (11.934 ± 5.836 vs 11.576 ± 5.857 vs 17.227 ± 8.889 mmHg m/s3 , P <.0001) was higher in the highest LVEF tertile along with relative wall thickness, midwall fractional shortening, endocardial fractional shortening, and R-W1 .
Conclusions:
Newly diagnosed hypertensives show increased LVM and LV contractility, including carotid WI parameters and R-W1 values, as compared with normotensive subjects, but no differences in LV diastolic function.
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