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Abstract

Background

Hypertension (HTN) and diabetes mellitus (DM) are prevalent cardiovascular disease states which have been shown to be associated with adverse cardiac remodelling and subclinical myocardial dysfunction. Myocardial work (MW) indices are novel non-invasive measures of left ventricular (LV) function. We aimed to characterise key differences in MW indices in patients with these conditions.

Methods

Outpatients with HTN and DM undergoing transthoracic echocardiography (TTE; 2016–2019) at our institution were assessed and compared to healthy controls. Only patients without cardiac disease with normal diastolic parameters on TTE were recruited. Patients with impaired LV function, cardiac ischaemia or arrhythmia, structural and valvular heart disease or poor-quality images were excluded. Recruited patients were stratified into 3 groups (Group1: Healthy Controls; Group 2: HTN; Group 3: HTN-DM). MW assessment was performed using GE E-95 EchoPac v2.2 system.

Results

Three hundred patients (57.3±17.4y, 51% female) were recruited. HTN and HTN-DM patients were associated with higher resting systolic blood pressure (SBP), indexed LV mass (LVMI), e' and E/e' compared to controls but no differences were noted in these parameters between HTN and HTN-DM. Global myocardial work index (GWI) was higher in HTN patients compared to Controls but not different compared to HTN-DM. Of interest, HTN-DM patients had higher global myocardial wasted work (GWW) and lower global myocardial work efficiency (GWE) compared to HTN patients and Controls.

Conclusions

MW indices may be a sensitive tool for the detection of subclinical changes in cardiac function in cardiometabolic disease states.

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Comparison between Groups

Total CohortGroup 1Group 2Group 3ANOVA
Controls (n=100)HTN (n=100)HTN and DM (n=100)p-value
Age (years)57.3±17.443.1±14.564.2±14.5†64.4±13.9‡<0.001
Men n (%)147 (49%)37 (37%)55 (55%)45 (45%)0.034
LVMI (g/m2)82.7±23.373.4±18.386.9±23.0†87.9±25.3‡<0.001
e' (m/s)0.08±0.030.10±0.030.06±0.02†0.06±0.02‡<0.001
E/e'10.6±4.48.5±3.112.6±4.9†12.6±4.1‡<0.001
LVEF (%)61±661±561±660±70.843
LVGLS (-%)20.0±4.820.6±2.220.5±7.319.0±3.20.053
GWI (mmHg%)1969±3901891±2982036±408†1981±4390.037
GCW (mmHg%)2256±4452175±3692316±4292279±5170.019
GWW (mmHg%)82.0±50.666.0±32.780.2±48.199.7±61.4‡*<0.001
GWE (%)95.5±2.596.4±1.495.8±2.094.4±3.3 ‡*<0.001
Total CohortGroup 1Group 2Group 3ANOVA
Controls (n=100)HTN (n=100)HTN and DM (n=100)p-value
Age (years)57.3±17.443.1±14.564.2±14.5†64.4±13.9‡<0.001
Men n (%)147 (49%)37 (37%)55 (55%)45 (45%)0.034
LVMI (g/m2)82.7±23.373.4±18.386.9±23.0†87.9±25.3‡<0.001
e' (m/s)0.08±0.030.10±0.030.06±0.02†0.06±0.02‡<0.001
E/e'10.6±4.48.5±3.112.6±4.9†12.6±4.1‡<0.001
LVEF (%)61±661±561±660±70.843
LVGLS (-%)20.0±4.820.6±2.220.5±7.319.0±3.20.053
GWI (mmHg%)1969±3901891±2982036±408†1981±4390.037
GCW (mmHg%)2256±4452175±3692316±4292279±5170.019
GWW (mmHg%)82.0±50.666.0±32.780.2±48.199.7±61.4‡*<0.001
GWE (%)95.5±2.596.4±1.495.8±2.094.4±3.3 ‡*<0.001

†Group 1 vs 2: p<0.05; ‡Group 1 vs 3: p<0.05; *Group 2 vs 3: p<0.05.

Funding Acknowledgement

Type of funding source: None

Tissue Doppler, Speckle Tracking and Strain Imaging
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