Depressed myocardial energetic efficiency is associated with increased cardiovascular risk in hypertensive left ventricular hypertrophy. Issue 9 (September 2016)

• Record Type: Journal Article
• Authors: de Simone, Giovanni; Izzo, Raffaele; Losi, Maria Angela; Stabile, Eugenio; Rozza, Francesco; Canciello, Grazia; Mancusi, Costantino; Trimarco, Valentina; De Luca, Nicola; Trimarco, Bruno
• Is Part Of: Journal of hypertension. Volume 34:Issue 9(2016:Sep.)
• Publication Date: 2016-09
• Subjects: cardiovascular risk -- hypertension -- left ventricular hypertrophy -- myocardial energetic efficiency; Hypertension -- Periodicals; Hypertension -- Periodicals; 616.132005
• DOI: 10.1097/HJH.0000000000001007
• Languages: English
• ISSNs: 1473-5598

Abstract

Abstract : Background and purpose: Myocardial mechano-energetic efficiency (MEE) can be easily approximated by the ratio of stroke work [i.e. SBP times stroke volume (SV)] to a rough estimate of energy consumption, the 'double product' [SBP times heart rate (HR)], which can be simplified as SV/HR. We evaluated whether MEE is associated with adverse prognosis in relation to the presence of left ventricular hypertrophy (LVH). Methods: Hypertensive participants of the Campania Salute Network ( n = 12 353) without prevalent coronary or cerebrovascular disease and with ejection fraction more than 50% were cross-sectionally and longitudinally analyzed, over a median follow-up of 31 months. MEE was estimated by echocardiographic SV (z-derived)/(HR × 0.6). Results: Due to the close relation with left ventricular mass (LVM) ( P < 0.0001), MEE was normalized for LVM (MEEi) and divided into quartiles. The lowest quartile of MEEi (<0.29 ml/s per g) was considered 'low MEEi'. MEEi was greater in women than in men ( P < 0.0001). Progressively lower MEEi was associated with older age, male sex, obesity, diabetes, LVH, concentric geometry, inappropriate LVM and diastolic dysfunction, more use of antihypertensive therapy, and higher BP (all P < 0.002). In Cox regression, after controlling for LVH, age, sex, and average follow-up SBP, low MEEi exhibited increased hazard of composite fatal and nonfatal cardiovascular end-points ( P < 0.01), independently of antihypertensive therapy and associated cardiovascular risk factors. Conclusion: A simple estimate of low myocardial mechano-energetic efficiency is associated with altered metabolic profile, LVH, concentric left ventricular geometry, and diastolic dysfunction and predicts cardiovascular end-points, independently of age, sex, LVH antihypertensive therapy, and cardiovascular risk factors.