title: Depressed myocardial energetic efficiency is associated with increased cardiovascular risk in hypertensive left ventricular hypertrophy.
abstract: 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).
  
  
  
  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).
  
  
  
  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.
  
  
  
  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.
authors.affiliation: aHypertension Research Center bDepartment of Advanced Translational Medical Sciences cDepartment of Biomedical Sciences dDepartment of Neurosciences, Federico II University Hospital, Napoli, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: de Simone
authors.forename: Raffaele
authors.initials: R
authors.lastname: Izzo
authors.forename: Maria Angela
authors.initials: MA
authors.lastname: Losi
authors.forename: Eugenio
authors.initials: E
authors.lastname: Stabile
authors.forename: Francesco
authors.initials: F
authors.lastname: Rozza
authors.forename: Grazia
authors.initials: G
authors.lastname: Canciello
authors.forename: Costantino
authors.initials: C
authors.lastname: Mancusi
authors.forename: Valentina
authors.initials: V
authors.lastname: Trimarco
authors.forename: Nicola
authors.initials: N
authors.lastname: De Luca
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
mesh_terms: D000328:Adult; D000368:Aged; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004452:Echocardiography; D004734:Energy Metabolism; D005260:Female; D006321:Heart / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000150:complications / Q000503:physiopathology*; D007558:Italy / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009206:Myocardium; D011379:Prognosis; D012307:Risk Factors; D013318:Stroke Volume