Association of impaired left ventricular twisting-untwisting with vascular dysfunction, neurohumoral activation and impaired exercise capacity in hypertensive heart disease

• Published in: European journal of heart failure Vol. 17; no. 12; pp. 1240 - 1251
• Main Authors: Ikonomidis, Ignatios, Tzortzis, Stavros, Triantafyllidi, Helen, Parissis, John, Papadopoulos, Costas, Venetsanou, Kyriaki, Trivilou, Paraskevi, Paraskevaidis, Ioannis, Lekakis, John
• Format: Journal Article
• Language: English
• Published: Oxford, UK John Wiley & Sons, Ltd 01.12.2015
• Subjects: Arterial stiffness; Biomarkers - blood; Blood Pressure; Coronary flow reserve; Echocardiography; Female; Heart Diseases - physiopathology; Heart Ventricles - physiopathology; Humans; Hypertension - physiopathology; LV diastolic dysfunction; LV twisting and untwisting; Male; Matrix Metalloproteinase 9 - blood; Middle Aged; Mitral Valve - physiopathology; Natriuretic Peptide, Brain - blood; Peptide Fragments - blood; Pulse wave velocity; Tissue Inhibitor of Metalloproteinase-1 - blood; Transforming Growth Factor beta - blood; Pulse wave velocity; Coronary flow reserve; LV twisting and untwisting; Arterial stiffness; LV diastolic dysfunction
• ISSN: 1388-9842; 1879-0844
• DOI: 10.1002/ejhf.403

Aims We investigated the association between left ventricular (LV) torsional deformation and vascular dysfunction, fibrosis, neurohumoral activation, and exercise capacity in patients with normal ejection fraction Methods and results In 320 newly‐diagnosed untreated hypertensive patients and 160 controls, we measured: pulse wave velocity (PWV); coronary flow reserve (CFR) by Doppler echocardiography; global longitudinal strain and strain rate, peak twisting, the percentage changes between peak twisting, and untwisting at mitral valve opening (%dpTw – UtwMVO), at peak (%dpTw – UtwPEF), and the end of early LV diastolic filling (%dpTw – UtwEDF) by speckle tracking imaging; transforming growth factor (TGFb‐1), metalloproteinase‐9 (MMP‐9), tissue inhibitor of matrix metalloptoteinase‐1(TIMP‐1), markers of collagen synthesis, and N‐terminal pro‐brain natriuretic peptide (NT‐proBNP). Oxygen consumption (VO2), measured by means of cardiopulmonary exercise test, was assessed in a subset of 80 patients. The PWV, CFR, longitudinal strain and strain rate, %dpTw‐UtwMVO, %dpTw‐UtwPEF, and %dpTw‐UtwEDF were impaired in hypertensive patients compared with controls. In multivariable analysis, CFR, PWV, LV mass, and systolic blood pressure were independent determinants of longitudinal strain, strain rate, and untwisting markers (P < 0.05). Increased TGFb‐1 was related with increased collagen synthesis markers, TIMP‐1 and MMP‐9 and these biomarkers were associated with impaired longitudinal systolic strain rate, untwisting markers, CFR and PWV (P < 0.05). Delayed untwisting as assessed by reduced %dpTw – UtwEDF was related with increased NT‐proBNP and reduced VO2 (P < 0.05). Conclusions Impaired LV untwisting is associated with increased arterial stiffness and coronary microcirculatory dysfunction, and is linked to reduced exercise capacity and neurohumoral activation in hypertensive heart disease. A fibrotic process may be the common link between vascular dysfunction and abnormal myocardial deformation.