Abstract 12171: Biomarkers and Echocardiographic Predictors of Myocardial Dysfunction in Patients With Hypertension
Introduction: The aim of the study was to clarify the basis of exertional dyspnea in patients with hypertension with well-controlled blood pressure and normal ejection fraction (EF).
Methods: 99 patients with hypertension of mean age 63±11 years: group A - 22 patients without symptoms; group B - 27 patients with exertional dyspnea; group C - 50 patients with overt heart failure (HF). Patients in groups A and B had normal resting echocardiography.Patients underwent echocardiography at rest and during submaximal exercise on a bicycle ergometer; cardiotrophin-1, cystatin C (CysC), syndecan-4, collagen III N-terminal propeptide (PIIINP), transforming growth factor beta (TGF-beta), tumor necrosis factor alpha (TNF-alpha), interleukin 1 receptor, type I (IL1R1), galectin-3 and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured.
Results: In test group B the level of PIIINP was higher than in group A (2.9±0.94 vs 1.27±1.03 ng/ml; p=0.0001). Patients in groups A and B were characterized by lower levels of cardiotrophin-1, syndecan-4, NT-proBNP, and CysC than in group C. The concentration of TGF-beta was lower in group C than in A and B (p=0.000). Groups A and B had comparable echocardiographic findings at rest except isovolumic relaxation time, which was higher in group B (104.87±19 vs 89.4±26 ms; p=0.03). In exertional echocardiography the patients from group B compared with group A had lower E’ and S’ according to tissue Doppler imaging(12.83±1 vs 14.94±3, p=0.02; 9.35±2 vs 10.98±2; p=0.01) and E/E’ ratio was increased in the symptomatic group as compared to controls (6.99±1 vs 5.91±1; p=0.03). A late diastolic mitral annular velocity (A') increase was observed in group A and a reduction in group B with a significant difference in [[Unable to Display Character: ∆]]A’ between these two groups (-0.62±2.46 vs 1.22±3.41; p=0.04).
Conclusions: PIIINP might be the first early biomarker for the development of HF in patients with hypertension. Patients with normal resting echocardiography can present exercise intolerance and breathlessness associated with reduced left atrial function, worse left ventricular relaxation and impaired function of the longitudinal fibers of myocardium on exercise. Exertional echocardiography may indicate patients with incipient HF with preserved EF.
Author Disclosures: A. Bielecka-Dabrowa: None. M. Michalska-Kasiczak: None. A. Gluba: None. J. Rysz: None. M. Banach: None.
- © 2014 by American Heart Association, Inc.