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Published on: February 13, 2021
Increased Myocardial Stiffness in Patients With High-Risk Left Ventricular Hypertrophy: The Hallmark of Stage-B Heart
Michinari Hieda1,2, Satyam Sarma1,2, Christopher M Hearon1,2
1Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas (M.H., S.S., C.M.H., K.A.D., J.M., M.S., B.E., D.P., S.L., M.M., E.H., B.D.L.).
Insights
Middle-aged individuals with left ventricular hypertrophy (LVH) and elevated cardiac biomarkers show increased left ventricular myocardial stiffness. This finding suggests a transitional state towards heart failure with preserved ejection fraction (HFpEF).
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Biomedical Engineering
Background:
- Middle-aged individuals with left ventricular hypertrophy (LVH) and elevated cardiac biomarkers face a high risk of developing heart failure with preserved ejection fraction (HFpEF).
- The underlying pathophysiological mechanisms for this elevated risk remain unclear.
- This study investigates whether increased left ventricular (LV) myocardial stiffness contributes to this high-risk state.
Purpose of the Study:
- To test the hypothesis that patients with LVH and elevated cardiac biomarkers exhibit increased LV myocardial stiffness compared to healthy controls.
- To identify myocardial stiffness as a potential marker for future HFpEF development.
Main Methods:
- Recruited 46 patients with LVH and elevated cardiac biomarkers, and 61 healthy controls.
- Utilized right heart catheterization and 3D echocardiography to assess LV pressure-volume relationships.
- Manipulated preload using lower body negative pressure and saline infusion.
Main Results:
- Patients with LVH demonstrated significantly lower LV distensibility compared to controls.
- LV myocardial stiffness was found to be nearly 30% greater in the LVH group (stiffness constant: 0.053±0.027) versus controls (0.042±0.020, P=0.028).
- Significant differences in body size, blood pressure, and pulmonary capillary wedge pressure were observed between groups.
Conclusions:
- Elevated LV myocardial stiffness in patients with LVH and biomarkers suggests a transitional stage towards HFpEF.
- This increased stiffness may represent an early marker for HFpEF.
- Further research is needed to explore interventions, like exercise training, to improve LV compliance and potentially prevent HFpEF manifestation.
Background:
Individuals with left ventricular hypertrophy (LVH) and elevated cardiac biomarkers in middle age are at high risk for the development of heart failure with preserved ejection fraction (HFpEF). However, it is unknown what the pathophysiological underpinnings of this high-risk state may be. We tested the hypothesis that patients with LVH and elevated cardiac biomarkers would demonstrate elevated left ventricular (LV) myocardial stiffness in comparison with healthy controls as a key marker for future HFpEF.
Methods:
Forty-six patients with LVH (LV septum >11 mm) and elevated cardiac biomarkers (N-terminal pro-B-type natriuretic peptide [>40 pg/mL] or troponin T [>0.6 pg/mL]) were recruited, along with 61 age- and sex-matched (by cohort) healthy controls. To define LV pressure-volume relationships, right heart catheterization and 3-dimensional echocardiography were performed while preload was manipulated using lower body negative pressure and rapid saline infusion.
Results:
There were significant differences in body size, blood pressure, and baseline pulmonary capillary wedge pressure between groups (eg, pulmonary capillary wedge pressure: LVH, 13.4±2.7 versus control, 11.7±1.7 mm Hg, P<0.0001). The LV was less distensible in LVH than in controls (smaller volume for the same filling pressure). When preload was expressed as transmural filling pressure (pulmonary capillary wedge pressure - right atrial pressure), LV myocardial stiffness was nearly 30% greater in LVH than in controls (LVH stiffness constant, 0.053±0.027 versus controls, 0.042±0.020, P=0.028).
Conclusions:
LV myocardial stiffness in patients with LVH and elevated biomarkers (stage-B HFpEF) is greater than in age- and sex-matched controls and thus appears to represent a transitional state from a normal healthy heart to HFpEF. Although the LV myocardial stiffness of patients with LVH is greater than that of healthy controls at this early stage, further studies are required to clarify whether interventions such as exercise training to improve LV compliance may prevent the full manifestation of the HFpEF syndrome in these high-risk individuals.
Clinical Trial Registration:
URL: https://www.clinicaltrials.gov. Unique identifiers: NCT03476785 and NCT02039154.
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