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The Influence of Resting, Exercise-Induced Hypertension and Cardiac Remodeling on Myocardial Work Indices
Session:
SESSÃO DE POSTERS 28 - ECOCARDIOGRAFIA DE STRESS
Speaker:
António Baptista Carvalho
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Cartazes
FP Number:
---
Authors:
António Carvalho; Rita Santos; Luís Cotrim; Lígia Mendes
Abstract
<p>Background: Hypertension is a leading risk factor for cardiovascular disease and can subtly affect myocardial function before clinical manifestation. Advanced myocardial mechanics, such as Myocardial Work (MW) indices—Global Work Efficiency (GWE), Global Work Index (GWI), Global Constructive Work (GCW), and Global Wasted Work (GWW)—offer sensitive measures of cardiac performance. The impact of hypertension left ventricular (LV) remodelling and hypertensive responses to exercise on these parameters remains underexplored.</p> <p>Aims: This study aimed to:<br /> 1. Compare MW parameters between hypertensive and normotensive individuals;<br /> 2. Investigate the impact of elevated resting blood pressure (BP) and hypertensive response during exercise on myocardial function;<br /> 3. Assess the influence of left ventricular remodeling on MW indices.</p> <p>Methods: We conducted a single-center study of 822 patients without known cardiovascular disease who underwent exercise echocardiography. Of these, 583 patients completed the test (achieving predicted METs >85%). Participants were stratified by hypertension status, baseline BP, exercise-induced hypertensive response and LV echocardiographic remodeling patterns, including concentric remodeling and concentric left ventricle hypertrophy (LVH).</p> <p>Results: Hypertension did not limit test completion. Hypertensive patients had higher E/e′ and significantly lower GWI compared to normotensive individuals. Left ventricular remodeling patterns, except for concentric hypertrophy, did not significantly affect MW indices. Concentric hypertrophy was associated with higher GWW (p=0.022). The most significant determinants of MW parameters were elevated baseline (BP) and hypertensive responses during exercise (p<0.05). Multivariate analysis identified concentric LVH and elevated baseline BP as the sole independent predictor of impaired MW indices, significantly affecting GWI, GCW, and GWW.</p> <p>Conclusion: Elevated baseline blood pressure and hypertensive responses during exercise significantly impair myocardial work, as evidenced by reductions in GWI and GCW and increases in GWW. Left ventricle remodeling also impacts myocardial efficiency by increasing wasted work. These findings underscore the importance of addressing blood pressure management to mitigate early myocardial dysfunction, even in the absence of overt cardiovascular disease.</p>
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