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Left Ventricular Dysfunction Assessed by Cardiac Time Analysis Among Different Geometric Patterns in Untreated Hypertension
The 15th Annual Scientific Meeting
JHFS
S139
Symposium 12 S12-1
S12-3
The Mechanisms for the Progression of Hypertensive Heart Disease to Heart Failure NAOYUKI HASEBE Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Asahikawa, Japan
Diabetes Mellitus and Congestive Heart Failure MASATO ODAWARA The Third Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan
Affecting 40 million Japanese, systemic hypertension remains a major public health problem associated with considerable morbidity and mortality. Hypertension clearly damages the cardiac and vascular systems over time, causing hypertensive heart disease, renal dysfunction and vascular remodeling. Hypertensive heart disease is a constellation of abnormalities that includes left ventricular hypertrophy (LVH), systolic and diastolic dysfunction, and their clinical manifestations including arrhythmias and symptomatic heart failure. The classic paradigm of hypertensive heart disease is that the LV wall thickens in response to elevated blood pressure as a compensatory mechanism to minimize wall stress. A recent clinical trial demonstrated that tighter control of systolic blood pressure was associated with a reduction in the development of LVH, emphasizing the importance of the pressure load itself. A typical manifestation of cardiac dysfunction of severe LVH is mainly selective to the subendocardium. The subendocardial dysfunction is classically attributable to the imbalance between myocardial metabolic demands and blood flow. However, some data indicate subendocardial dysfunction may be an active protective mechanism reducing the requirement for enhanced subendocardial perfusion. The progression of hypertensive heart disease appears to be associated with progressive adverse remodeling of the extracellular matrix and increase in LV filling pressures. The mechanisms for the progression from asymptomatic concentric LVH to clinical heart failure with a preserved LVEF are just now being unraveled.
S12-2 Salt and Cardio-Renal Connection GENJIRO KIMURA Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Nagoya, Japan I. Salt Sensitivity, Glomerular Hypertension and Nocturnal Hypertension In all animal models examined whose blood pressure (BP) is sensitive to changes in salt intake, glomerular BP indeed proved elevated. In fact, we quantitatively estimated glomerular BP elevated in this type of hypertension. We also showed that BP failed to fall during night in patients with salt sensitive type of hypertension, and they manifested as non-dippers. In addition, high cardiovascular event rates were recognized in salt sensitive patients than in non-salt sensitive patients. II. Cardio-Renal Connection and Salt Sensitivity When salt intake is excessive in salt sensitive patients, the defect in sodium excretory capability becomes evident, making BP during night elevated, that is nocturnal hypertension, in order to compensate for diminished natriuresis during daytime and to enhance pressure-natriuresis during night. The nocturnal hypertension or non-dipper causes cardiovascular events. When excess salt intake is loaded in salt sensitive state, glomerular capillary pressure is also elevated, resulting in glomerular sclerosis and eventual renal failure. In this way, salt sensitivity and excess salt intake contribute to both cardiovascular and renal damages at the same time. We propose that salt sensitivity of BP and excess salt intake play an important role in the genesis of cardio-renal connection. Salt sensitivity and circadian rhythm of BP are the keys to connect cardiovascular and renal complications.
Diabetes Mellitus and Congestive Heart FailureMasato Odawara, The Third Department of Internal Medicine, Tokyo Medical University Type 2 diabetes has become prevalent all over the world including Japan. The number of the patients with diabetes mellitus is estimated to be 8.9 million in Japan. Treatment of diabetes should be focused on the prevention of various diabetic chronic complications. It is widely known that diabetes is an important risk factor for the development of coronary heart disease. Patients with type 2 diabetes have an increased risk for the development of hypertension and dyslipidemia. These cardiovascular risk factors contribute in combination to the development of coronary heart disease. Patients with type 2 diabetes have also an increased risk for the development of congestive heart failure in the presence or absence of coronary heart disease. The development of congestive heart failure leads to increased risk of premature death in these patients. The risk factors contributing to the development of congestive heart failure are going to be discussed in patients with diabetes mellitus. And the treatment of diabetes mellitus focusing on the prevention of heart diseases will be discussed.
S12-4 Left Ventricular Dysfunction Assessed by Cardiac Time Analysis Among Different Geometric Patterns in Untreated Hypertension KUNITSUGU TAKASAKI, MASAAKI MIYATA, CHUWA TEI Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan Left ventricular (LV) hypertrophy is a powerful independent predictor of morbidity and mortality in hypertension. Abnormal LV geometric patterns also associated with hypertensive complications, and patients with concentric hypertrophy have the highest mortality in hypertension. However, relation between the geometric patterns and cardiac dysfunction is not fully established. We hypothesized that Tei index, which reflects global cardiac function, can be a better parameter for estimating cardiac dysfunction among different LV geometric patterns in hypertension. Consecutive 60 untreated hypertensive patients were enrolled. According to LV mass index and relative wall thickness, subjects were divided into 4 groups; normal geometry, concentric remodeling, eccentric hypertrophy and concentric hypertrophy. We measured ejection fraction, mitral E/A, Tei index, ejection time, isovolumic contraction and relaxation time. As the results, Systolic blood pressure, ejection fraction, mitral E/A and Tei index significantly correlated with LV mass index. The multiple regression analysis demonstrated that only Tei index independently correlated with LV mass index (P!0.01). Tei index in concentric hypertrophy group was significantly greater than that in normal geometry (0.5160.11 vs. 0.3860.12, P!0.05). Isovolumic contraction time in concentric hypertrophy was significantly greater compared with all other groups (p!0.05). In conclusion, Tei index was feasible for estimation of LV dysfunction in hypertensive hypertrophy and LV function in concentric hypertrophy was most impaired among all the geometric patterns in untreated hypertension.
JHFS
S139
Symposium 12 S12-1
S12-3
The Mechanisms for the Progression of Hypertensive Heart Disease to Heart Failure NAOYUKI HASEBE Cardiovascular, Respiratory and Neurology Division, Asahikawa Medical University, Asahikawa, Japan
Diabetes Mellitus and Congestive Heart Failure MASATO ODAWARA The Third Department of Internal Medicine, Tokyo Medical University, Tokyo, Japan
Affecting 40 million Japanese, systemic hypertension remains a major public health problem associated with considerable morbidity and mortality. Hypertension clearly damages the cardiac and vascular systems over time, causing hypertensive heart disease, renal dysfunction and vascular remodeling. Hypertensive heart disease is a constellation of abnormalities that includes left ventricular hypertrophy (LVH), systolic and diastolic dysfunction, and their clinical manifestations including arrhythmias and symptomatic heart failure. The classic paradigm of hypertensive heart disease is that the LV wall thickens in response to elevated blood pressure as a compensatory mechanism to minimize wall stress. A recent clinical trial demonstrated that tighter control of systolic blood pressure was associated with a reduction in the development of LVH, emphasizing the importance of the pressure load itself. A typical manifestation of cardiac dysfunction of severe LVH is mainly selective to the subendocardium. The subendocardial dysfunction is classically attributable to the imbalance between myocardial metabolic demands and blood flow. However, some data indicate subendocardial dysfunction may be an active protective mechanism reducing the requirement for enhanced subendocardial perfusion. The progression of hypertensive heart disease appears to be associated with progressive adverse remodeling of the extracellular matrix and increase in LV filling pressures. The mechanisms for the progression from asymptomatic concentric LVH to clinical heart failure with a preserved LVEF are just now being unraveled.
S12-2 Salt and Cardio-Renal Connection GENJIRO KIMURA Department of Cardio-Renal Medicine and Hypertension, Nagoya City University, Nagoya, Japan I. Salt Sensitivity, Glomerular Hypertension and Nocturnal Hypertension In all animal models examined whose blood pressure (BP) is sensitive to changes in salt intake, glomerular BP indeed proved elevated. In fact, we quantitatively estimated glomerular BP elevated in this type of hypertension. We also showed that BP failed to fall during night in patients with salt sensitive type of hypertension, and they manifested as non-dippers. In addition, high cardiovascular event rates were recognized in salt sensitive patients than in non-salt sensitive patients. II. Cardio-Renal Connection and Salt Sensitivity When salt intake is excessive in salt sensitive patients, the defect in sodium excretory capability becomes evident, making BP during night elevated, that is nocturnal hypertension, in order to compensate for diminished natriuresis during daytime and to enhance pressure-natriuresis during night. The nocturnal hypertension or non-dipper causes cardiovascular events. When excess salt intake is loaded in salt sensitive state, glomerular capillary pressure is also elevated, resulting in glomerular sclerosis and eventual renal failure. In this way, salt sensitivity and excess salt intake contribute to both cardiovascular and renal damages at the same time. We propose that salt sensitivity of BP and excess salt intake play an important role in the genesis of cardio-renal connection. Salt sensitivity and circadian rhythm of BP are the keys to connect cardiovascular and renal complications.
Diabetes Mellitus and Congestive Heart FailureMasato Odawara, The Third Department of Internal Medicine, Tokyo Medical University Type 2 diabetes has become prevalent all over the world including Japan. The number of the patients with diabetes mellitus is estimated to be 8.9 million in Japan. Treatment of diabetes should be focused on the prevention of various diabetic chronic complications. It is widely known that diabetes is an important risk factor for the development of coronary heart disease. Patients with type 2 diabetes have an increased risk for the development of hypertension and dyslipidemia. These cardiovascular risk factors contribute in combination to the development of coronary heart disease. Patients with type 2 diabetes have also an increased risk for the development of congestive heart failure in the presence or absence of coronary heart disease. The development of congestive heart failure leads to increased risk of premature death in these patients. The risk factors contributing to the development of congestive heart failure are going to be discussed in patients with diabetes mellitus. And the treatment of diabetes mellitus focusing on the prevention of heart diseases will be discussed.
S12-4 Left Ventricular Dysfunction Assessed by Cardiac Time Analysis Among Different Geometric Patterns in Untreated Hypertension KUNITSUGU TAKASAKI, MASAAKI MIYATA, CHUWA TEI Department of Cardiovascular, Respiratory and Metabolic Medicine, Graduate School of Medicine, Kagoshima University, Kagoshima, Japan Left ventricular (LV) hypertrophy is a powerful independent predictor of morbidity and mortality in hypertension. Abnormal LV geometric patterns also associated with hypertensive complications, and patients with concentric hypertrophy have the highest mortality in hypertension. However, relation between the geometric patterns and cardiac dysfunction is not fully established. We hypothesized that Tei index, which reflects global cardiac function, can be a better parameter for estimating cardiac dysfunction among different LV geometric patterns in hypertension. Consecutive 60 untreated hypertensive patients were enrolled. According to LV mass index and relative wall thickness, subjects were divided into 4 groups; normal geometry, concentric remodeling, eccentric hypertrophy and concentric hypertrophy. We measured ejection fraction, mitral E/A, Tei index, ejection time, isovolumic contraction and relaxation time. As the results, Systolic blood pressure, ejection fraction, mitral E/A and Tei index significantly correlated with LV mass index. The multiple regression analysis demonstrated that only Tei index independently correlated with LV mass index (P!0.01). Tei index in concentric hypertrophy group was significantly greater than that in normal geometry (0.5160.11 vs. 0.3860.12, P!0.05). Isovolumic contraction time in concentric hypertrophy was significantly greater compared with all other groups (p!0.05). In conclusion, Tei index was feasible for estimation of LV dysfunction in hypertensive hypertrophy and LV function in concentric hypertrophy was most impaired among all the geometric patterns in untreated hypertension.