Usability of myocardial work parameters to demonstrate subclinical myocardial involvement in normotensive individuals with exaggerated hypertensive response in treadmill exercise testing

Süleyman Cagan Efe; Mahmut Buğrahan Cicek; Tuba Unkun; Enver Yucel; Ali Karagöz; Cem Doğan; Zübeyde Bayram; Ali Furkan Tekatlı; Baver Bozan; Murat Karaçam; Gülümser Sevgin Halil; Turgut Karabağ; Cihangir Kaymaz; Nihal Ozdemir

doi:10.1111/jch.14814

Usability of myocardial work parameters to demonstrate subclinical myocardial involvement in normotensive individuals with exaggerated hypertensive response in treadmill exercise testing

J Clin Hypertens (Greenwich). 2024 Apr 11. doi: 10.1111/jch.14814. Online ahead of print.

Affiliations

¹ Department of Cardiology, Kartal Kosuyolu Education and Research Hospital, Istanbul, Turkey.
² Department of Cardiology, Istanbul Education and Research Hospital, Istanbul, Turkey.

PMID: 38605567
DOI: 10.1111/jch.14814

Abstract

Early determination of changes in myocardial functions is essential for the protection of cardiovascular diseases. This study aimed to evaluate myocardial work parameters in healthy individuals who developed an exaggerated hypertensive response during the treadmill exercise test procedure. The study included a total of 64 patients for whom an exercise electrocardiography test was planned for functional capacity evaluation. The study population was divided according to the presence of exaggerated hypertensive response to exercise (EBPRE) (SBP/DBP ≥210/105 mmHg in males ≥190/105 mmHg in females) and normal blood pressure response to exercise (NBPRE). Patients' echocardiographic evaluations were made at rest, and myocardial work parameters were calculated. There was no statistical difference between the groups (NBPRE vs. EBPRE, respectively) in terms of left ventricular 2,3 and 4 chamber strains and global longitudinal strain (GLS) values (-20.6 ± -2.3, -19.7 ± -1.9, p:.13; -21.3 ± -2.7, -21 ± -2.4, p:.68; -21.2 ± -2.2, -21.2 ± -2.3, p:.93; and -20.8 ± -1.5, -20.4 ± -1.5, p:.23, respectively). Global constrictive work (GCW), global waste work (GWW), and global work efficiency (GWE) were not statistically different between the two groups (2374 ± 210, 2465 ± 204, p:.10; 142 ± 64, 127 ± 42, p:.31; 94.3 ± 2.5, 95.1 ± 1.5, p:.18, respectively). In contrast, global work index (GWI) parameters were different between the two groups (2036 ± 149, 2147 ± 150, p < .001). The GWI was independently associated with EBPRE (odds ratio with 95% 3.32 (1.02-11.24), p = .03). The partial effect plots were used for GWI to predict EBPRE, according to the results, an increase in GWI predicts probability of exaggerated hypertensive response. In conclusion, Myocardial work analyses might be used to identify early signs of myocardial involvement in normotensive patients with EBPRE.

Keywords: Myocardial work parameters; echocardiography; hypertension; hypertensive response exercise; myocardial work index.