CLINICAL RESEARCH: STRESS TESTING
Patients with a hypertensive response to exercise have impaired systolic function without diastolic dysfunction or left ventricular hypertrophy
Philip M. Mottram, MBBS, FRACP*,
Brian Haluska, MS*,
Satoshi Yuda, MD*,
Rodel Leano, BS* and
Thomas H. Marwick, MBBS, PhD, FACC*,*
* University of Queensland, Brisbane, Australia
Manuscript received March 14, 2003;
revised manuscript received August 21, 2003,
accepted August 25, 2003.
* Reprint requests and correspondence: Prof. Thomas H. Marwick, Department of Medicine, University of Queensland, Princess Alexandra Hospital, Ipswich Road, Brisbane Q4102, Australia.
tmarwick{at}soms.uq.edu.au
OBJECTIVES: We sought to determine if a hypertensive response to exercise (HRE) is associated with myocardial changes consistent with early hypertensive heart disease.
BACKGROUND: An HRE predicts the development of chronic hypertension (HT) and may reflect a preclinical stage of HT.
METHODS: Patients with a normal left ventricular (LV) ejection fraction and a negative stress test were recruited into three matched groups: 41 patients (age 56 ± 10 years) with HRE (>210/105 mm Hg in men; >190/105 in women), comprising 22 patients with (HT+) and 19 without resting hypertension (HT–); and 17 matched control subjects without HRE. Long-axis function was determined by measurement of the strain rate (SR), peak systolic strain, and cyclic variation (CV) of integrated backscatter in three apical views.
RESULTS: An HRE was not associated with significant differences in LV mass index. Exercise performance and diastolic function were reduced in HRE(HT+) patients, but similar in HRE(HT–) patients and controls. Systolic dysfunction (peak systolic strain, SR, and CV) was significantly reduced in HRE patients (p < 0.001 for all). These reductions were equally apparent in patients with and without a history of resting HT (p = NS) and were independent of LV mass index and blood pressure (p < 0.01).
CONCLUSIONS: An HRE is associated with subtle systolic dysfunction, even in the absence of resting HT. These changes occur before the development of LV hypertrophy or detectable diastolic dysfunction and likely represent early hypertensive heart disease.
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Abbreviations and Acronyms
| | Aa | = late diastolic mitral annular velocity | | BP | = blood pressure | | CV | = cyclic variation | | Ea | = early diastolic mitral annular velocity | | HRE | = hypertensive response to exercise | | HT | = hypertension | | IB | = integrated backscatter | | LV | = left ventricle/ventricular | | SR | = strain rate |
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