Early left ventricular mechanics abnormalities in prehypertension: a two-dimensional strain echocardiography study.
BACKGROUND
Prehypertension predicts established hypertension. In this study, the aim was to analyze left ventricular (LV) mechanics in borderline prehypertensive (pre-HT) and hypertensive (HT) subjects through two-dimensional (2D)-strain echocardiography and then evaluate possible relations between cardiac parameters and insulin metabolism (homeostasis model assessment of insulin resistance (HOMA(IR)).


METHODS
Seventy-four consecutive newly diagnosed, untreated HT were divided, on the basis of their office blood pressure (BP) measurements, confirmed by ambulatory BP monitoring (ABPM), in 41 borderline pre-HT (ABPM: 122.5 +/- 6.7/76.2 +/- 5.2 mm Hg) and 33 never-treated mild HT (ABPM: 138.3 +/- 7.3/87.6 +/- 7.1 mm Hg). Thirty-three healthy normotensive (NT) controls (ABPM: 114.8 +/- 6.3/73.1 +/- 6.1 mm Hg) (P < 0.0001) were also studied (NT). All subjects performed 2D color Doppler and pulsed-wave tissue Doppler imaging (PW-TDI).


RESULTS
Left ventricular mass (LVM) was significantly higher in pre-HT (39.2 +/- 8.7 g/m(2.7)) and in HT (43.6 +/- 8.5 g/m(2.7)) compared with NT (30.9 +/- 7.4 g/m(2.7)) (P < 0.0001). A mild LV diastolic dysfunction was found both with Doppler mitral flow velocity and PW-TDI at mitral annulus level analysis. Longitudinal 2D strain in pre-HT (-18.9% +/- 3.4) and in HT (-18.0% +/- 3.3) was significantly lower than in NT (-23.9% +/- 3.0) (P < 0.002). These LV abnormalities were associated with systolic ABPM, LVM, and HOMA(IR).


CONCLUSIONS
Early abnormalities of LV longitudinal systolic deformation were found both in pre-HT and HT, together with a mild LV diastolic dysfunction. In both groups this early cardiac systolic and diastolic dysfunction is associated to insulin resistance, systolic pressure load, and cardiac remodeling.
Di Bello
Vitantonio
V
Cardiac and Thoracic and Vascular Department, University of Pisa, Pisa, Italy. vdibello@med.unipi.it
Talini
Enrica
E
Dell'Omo
Giulia
G
Giannini
Cristina
C
Delle Donne
Maria Grazia
MG
Canale
Maria Laura
ML
Nardi
Carmela
C
Palagi
Caterina
C
Dini
Frank Lloyd
FL
Penno
Giuseppe
G
Del Prato
Stefano
S
Marzilli
Mario
M
Pedrinelli
Roberto
R
D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D001795:Blood Pressure Determination; D002784:Cholesterol / Q000097:blood; D004452:Echocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000000981:diagnostic imaging* / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D014280:Triglycerides / Q000097:blood; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging*; D020257:Ventricular Remodeling
D001786:Blood Glucose; D007328:Insulin; D014280:Triglycerides; D002784:Cholesterol