title: Cardiovascular maladaptation to exercise in young hypertensive patients.
abstract: BACKGROUND
  Impairment of the adaptive mechanisms that increase cardiac output during exercise can translate to a reduced functional capacity. We investigated cardiovascular adaptation to exertion in asymptomatic hypertensive patients, aiming to identify the early signs of cardiac and vascular dysfunction.
  
  
  RESULTS
  We enrolled 54 subjects: 30 patients (45.1±11.9years, 19 males) and 24 age-matched healthy controls (44.4±9.6years, 14 males). Speckle-tracking echocardiography (STE) and echo-tracking were performed at rest and during exertion to assess myocardial deformation and arterial stiffness.
  
  
  RESULTS
  E/E' increased from rest to peak exercise more in patients than in controls (peak stage: p=0.024). Global longitudinal strain increased significantly from rest to peak stage in controls (p=0.011) whereas it remained unchanged in patients (p=0.777). Left atrial (LA) reservoir was significantly increased throughout the exercise only in controls (p=0.001) whereas it was almost unchanged in patients (p=0.293). LA stiffness was significantly higher in patients than in controls both at rest (p=0.023) and during exercise (p<0.001). Beta index and pulse wave velocity (PWV) increased during exercise in both groups, showing higher values in patients in each step.
  
  
  CONCLUSIONS
  Our study showed a more pronounced maladaptation during exercise, with respect to rest, of the cardiovascular system with impaired cardiac-vessel coupling in hypertensive patients compared to healthy subjects. Exercise echocardiography implemented by STE and echo-tracking is invaluable in the early detection of these cardiovascular abnormalities.
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Cusmà Piccione
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.affiliation: Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, 2801 W. Kinnickinnic River Parkway, Ste. 840, Milwaukee, WI 53215, USA. Electronic address: publishing22@aurora.org.
authors.forename: Bijoy
authors.initials: B
authors.lastname: Khandheria
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Madaffari
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Oteri
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Falanga
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Donato
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Myriam
authors.initials: M
authors.lastname: D'Angelo
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Maria Ludovica
authors.initials: ML
authors.lastname: Carerj
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Gianluca
authors.initials: G
authors.lastname: Di Bella
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Egidio
authors.initials: E
authors.lastname: Imbalzano
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Pugliatti
authors.affiliation: Department of Clinical-Experimental Medicine and Pharmacology, Cardiology Division, University of Messina, Via Consolare Valeria, Messina, ME 98122, Italy.
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
mesh_terms: D000222:Adaptation, Physiological; D000328:Adult; D002302:Cardiac Output / Q000502:physiology; D018618:Echocardiography, Doppler, Color; D005080:Exercise Test; D017079:Exercise Tolerance / Q000502:physiology*; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D006973:Hypertension / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D059289:Vascular Stiffness / Q000502:physiology*; D016277:Ventricular Function, Left / Q000502:physiology*
keywords: Echo-tracking; Exercise echocardiography; Longitudinal function; Stiffness; Strain