Abnormal left ventricular and left atrial mechanics in patients with resistant hypertension

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Abstract Introduction Patients with resistant hypertension (RH) suffer from a high rate of cardiovascular (CV) complications and have poor prognosis. Given the poor prognosis in RH patients, early identification of subclinical myocardial abnormalities is of clinical importance to allow for timely preventive therapeutic interventions. Speckle tracking echocardiography (STE) is a valuable technique to detect subclinical myocardial dysfunction in hypertensive patients and, therefore, could assist in clinical risk stratification and provide important therapeutic implications. Purpose The study aimed to investigate whether left ventricular (LV) and left atrial (LA) myocardial mechanics are impaired in patients with RH compared to controlled hypertension (CH) patients and normotensive controls (NC). Methods This was a prospective cross-sectional study in which 54 age and sex-matched participants: 17 with RH (mean age 60.5±12.4 years), 18 with CH (57.7±12.2 years), and 19 NC (54.7±11.9 years) were consecutively recruited. Clinical and conventional echocardiographic measurements were obtained, followed by a two-dimensional STE analysis to assess LV and LA strain. Stepwise multivariable linear regression analysis was performed to identify independent predictors of LV and LA strain indices. Results The demographical characteristics were similar across the three groups (Table 1). Patients with RH had elevated BP readings and pronounced cardiac remodelling compared to CH and NC (p<0.001). Peak systolic global longitudinal strain (GLS) was lower in RH and CH groups compared to NC (RH: -16.7±1.9% and CH: -19.8±1.4% vs NC: -21.4±1.3%; p<0.001 and p=0.005, respectively), and being lower in RH compared to CH (p<0.001). Peak systolic global circumferential strain (GCS) was lower between RH and NC (RH: -18.3±3.6% vs NC: -21.7±2.2%, p=0.004) but not between RH and CH (RH: -18.3±3.6% vs CH: -20.3±2.9%, p=0.13). Peak systolic global radial strain (GRS) was lower in RH than in CH and NC (RH: 32.8±8.1% vs CH: 45.0±8.9% and NC: 49.1±5.2%, p<0.001 for all). LV twist was similar amongst the three groups (p>0.05). For the LA longitudinal strain indices, patients with RH had significantly lower reservoir, conduit, and pump strains than NC (p<0.001, p<0.001 and p=0.04, respectively) and CH (p=0.01, p=0.02 and p=0.02, respectively). Of note, the presence of RH remained independently associated with worse GLS (β=3.1, p<0.001), GRS (β= -8.6, p<0.001), LA reservoir (β= -6.0, p=0.005) and pump strains (β=3.5, p=0.007) after adjusting for demographical and clinical variables (Table 2). Conclusion Patients with RH show evidence of greater cardiac remodelling with subclinical impairment of their LV and LA mechanics when compared to CH and NC. The subclinical identification of myocardial abnormalities in patients with RH may provide a therapeutic window of opportunity for their reversal and potentially mitigate the occurrence of accompanied CV complications.

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