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Distribution of myocardial work in arterial hypertension: insights from non-invasive left ventricular pressure-strain relations

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Abstract

A index of non-invasive myocardial work (MWI) can account for pressure during the assessment of cardiac function, potentially separating the influence of loading conditions from the influence of the underlying tissue remodelling. The aim is to assess LV function accounted for loading and explore hypertensive MWI distribution by comparing healthy individuals to hypertensive patients without and with localized basal septal hypertrophy (BSH). An echocardiogram was performed in 170 hypertensive patients and 20 healthy individuals. BSH was defined by a basal-to-mid septal wall thickness ratio ≥ 1.4. LV speckle-tracking was performed, and the MWI calculated globally and regionally for the apical, mid and basal regions. An apex-to-base gradient, seen in regional strain values, was preserved in the distribution of myocardial work, with the apical region compensating for the impairment of the basal segments. This functional redistribution was further pronounced in patients with localized BSH. In these patients, segmental MWI analysis revealed underlying impairment of regional work unrelated to acute loading conditions. Non-invasive MWI analysis offers the possibility to compare LV function regardless of blood pressure at the time of observation. Changes in MWI distribution can be seen in hypertension unrelated to the load-dependency of strain. Accentuated functional changes affirm the role of BSH as an echocardiographic marker in hypertension.

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Funding

This work was supported by Horizon 2020 European Commission Project H2020-MSCA-ITN-2016 (764738), Grant from Fundacio La Marató de TV3 (040310, Exp 2015.40.30), and from Fondo de Investigaciones Sanitarias - Instituto de Salud Carlos III (PI17/01131). PL holds a Wellcome Trust Senior Research Fellowship (209450/Z/17/Z).

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Author notes

  1. Bart Bijnens and Marta Sitges contributed equally as senior authors.

Authors and Affiliations

  1. Institute of Biomedical Research August Pi Sunyer (IDIBAPS), Carrer del Rosselló, 149, 08036, Barcelona, Spain

    Filip Loncaric, Loredana Nunno, Maria Mimbrero, Laura Sanchis, Adelina Doltra, Silvia Montserrat, Bart Bijnens & Marta Sitges

  2. Department of Biomedical Engineering, Kings College London, London, UK

    Maciej Marciniak, Joao F. Fernandes & Pablo Lamata

  3. Cardiovascular Institute, Hospital Clínic and Universitat de Barcelona, Barcelona, Spain

    Loredana Nunno, Maria Mimbrero, Laura Sanchis, Adelina Doltra, Silvia Montserrat & Marta Sitges

  4. University Hospital Centre Zagreb, Department for Cardiovascular Diseases and University of Zagreb School of Medicine, Zagreb, Croatia

    Dora Fabijanovic & Maja Cikes

  5. CIBERCV, Instituto de Salud Carlos III (CB16/11/00354); CERCA Programme / Generalitat de Catalunya, Madrid, Spain

    Silvia Montserrat & Marta Sitges

  6. La Institució Catalana de Recerca i Estudis Avançats, (ICREA), Barcelona, Spain

    Bart Bijnens

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  1. Filip Loncaric
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Correspondence to Filip Loncaric.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Comite Etico de Investigacion Clinica, Hospital Clinic, Barcelona, Reference Number: HCB/2015/0455.

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Loncaric, F., Marciniak, M., Nunno, L. et al. Distribution of myocardial work in arterial hypertension: insights from non-invasive left ventricular pressure-strain relations. Int J Cardiovasc Imaging 37, 145–154 (2021). https://doi.org/10.1007/s10554-020-01969-4

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  • DOI: https://doi.org/10.1007/s10554-020-01969-4

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