Obesity influences left ventricular filling in essential hypertension

AJH-APRIL 1995-VOL.8, NO.4, PART 2

174A ASH ABSTRACrS

842

041 IMPAIRI:MENT OF LEn VEII/TR1CULAR :rONTRACTILI1'V IN HYPERTENSIVES WITH UNSTABLE ANGlNA Pi Somma S.•-D" 'Slliili &.,Carotenuto A.,de Diviliis M.•-Bramucci E.,Galderisi M.•$Jl.ngoli L.•"'S,Pecchia G.,deDivitiis 0 .. Clinical Methodology, University. Naples; - Cardiology IReCS. Pa"il'! Inpatients (pts) willt u",slable angina (UA) the presence of hypcJ".~nsion is very common and induces a poor prognosis mninly due to worsening of left ventricular function. In orderto evaluate if this left ventricular failure is due to an allcration of m)'ocardial conrraclilily, we invasiH:ly stuwed 16 pts \\ilh class II-III B Braunwald U.\ PIS were divided in 2 groups: ischaemic-hypertensives (IH:n"7) and ischaemic-normotens'ves (IN;n=!1) comparable for the severity of ischaemia. Before undergiJ:ng PTCA for Isolated stenosis of Coronal)' Descending Artery (> 15% coronary sngiography quantilIltive evaluation) a Millar Catheter was used for haemodynamic paramethers evaluation (LVSP, EDP. +dp/dt. dp/dt. Vpm. Dpm) before and afler ischaemic handgrip test. RemIts: IN IH Res! LSVP IiDr

HR +dp/ell V"m -dpldl DPmin

143.8!,19 IS,8±S 63,8±12 113'.i206 26,4:'4,3 1419±296 7,t<2.6

Handgrip

RCIXl\'Cl)'

RCSl

161,4,i23 21 ,6±6° 74.!;15 1342.!;296 22.5!,4° "63.!;290 12,S.:'o

155,3:.U IS.S.!;3 63.7.!;7,8 1146'!71 24,2+4 J436!288 7.7!.2.6

I IS.S±12· ! 4.5:.4 71.7:'16 I3,O;!:17S' 32.6.!;6· '267;!:381 8.7,tS.6

Ilandgrip 136.8t.20· /2,5±7' 79,6±1l 1.196+4(10 31.7i5· U26+58O 11.7~7.6

Recovery

It9.I.!;IS· 13.2:!,Q

70.2;!,16 I I 84±300 28.7!8 J268,i.43$ 9.6.!;4.1

.p
KeyWords: Hypertension, Unstable Angina, Left Ventricular Funelioll. Myocardial Contractility.

OBESITY INFLUENCES LEFT VENTRICULAR FILUNG IN eSSENTIAL HYPERTENSION, G.F.Mureddu, G. de $fmo!J.!t, R. Groco, G.F. Roseto, F. Conlaldo. Federico II University Hospital, Naples, Italy To ve.: jfy whether obesity influences left ventricular (LV) filling ir1 arterial hypertension, Doppler LV diastolic flow was compared in 18 hypert6nsive obese patients (OH, 7 men, 11 women; age: 49:1:15 years; b"dy mass index (BMI): 39:t7; blood pressure (BP):162±26/96:t10 mmHg), 31 n01motensive obese subjects (ON, 10 men, 21 women, age: 33:1:13 years; BMI:37:t6; BP=:125:1:14r14:1:10 mmHg) and 37 ncrmotenslve normal-weight controls (NN; 16 men. 21 women, age: 36t14 years; BMI:23:t4; BP=120:t141 72:t10 m,llHg), by ANOVA after adjusting (ANCOVA) for confounders {age, syslulic and diastolic BP and R-R time~ . OH exhibited higher LV mass/heighe·7 (LVMI; 53:1:17 g/m 2• ) than ON (36%10 g/m2.7) and NN (26t8 g/m2.7) (both p
Key Words:

B43

844

Echocard:oRmphic Characteristics of Dllated Cardiumyopathy and Ad,aClced Heurt Failure Are Innuellced fly Hypertension Dnd Diabetes

Conl!estive Heart Failnc (eHF): Influence of Hypertension With nnd Without Diabetes Mellitus on CircadianVoriation in Autonomic Balr.nee E. Kenneth Kerut, John Winterlon, Louise Roflidal, Gary Sander, Robert Jones, Mich~el Given, Thomas Giles, Cardiovascular Research Laboratory, L.S.U. School of Medicine, New Orleans, LA We tested the hypothesis thal the circadian variation ill autonomic balance (sympathetic: J'llrasympathetic activity) in patients with CHF due to hypertension an diabetes mellitus differed from ClfF of othet etiologies. Accordingly, werecorded 24-hour ambulatory blood pressure {BP) andelectrocardiogram (ECG) andBn31yzed morning (AM) (9 AM11 AM) and eveninll (PM) (I AM - 3 AM) heart rate(HR) variability, using S12·beal segments, in bolhthe time and frequency domain (using a fast-Fourier algorithm) from 29 patients with CHF (left ventricular ejection fraction (LVEFJ < 30%: NYHA class m·IV) in sinus rhythm, treated with digitalis. diuretic and ACE inhibitor: Group 1: nanhypertensive non-diabetic (n = II); Group 2: non-hypertensive diabetic (n = 3); Group 3: hypertensive non-diabetic (n'''' 8): Group 4: hypertensive diabetic (n '"' :i). There were no differences in ii.1lliJl I3P, mean HR Of mean LVEF among the $.roups. No difference existed in thetime domain analysis of HRvariability, The ratio of lowHz (0.02 0.15 Hz, sympathetic) : high Hz (0.15·0.5, pBl'lIsympnlhetic) power determined by power spectral analysis of HR variability was used to estimate sympathovagal balance (SVB). Normalized units (NU) forhiSh· andlow-power spectra were calculated bydividing each spectra by total power.

E. Kenneth Kerot, Arthur Eberly, Elizabeth Mcilwain, Gayle Allen, Frnncisco Tadeu, Louise Roffidal, Michael Given, Robert Jones, Thomas Giles, Cardiovascular Research Laboratory, L.S.V. School of Medlvine, New Orleans, LA Hypertension and diabetes mellitus are each associated with anatomically distinct cardiac characterislics in experimental animal models and human postmortem studies. We tested the hypothesis thaI these characleristics would persist in patients with advanced heart failure. 2·D echocanliograms and Doppler flow studies were recorded from 29 palients with congestive heart failure (CHF) (leftventricular ejection fraction ILVEFl < 30%) on treatment with digitalis, diuretics and ACE inhibilor, and analyzed (using anal:,rsis of variance) by group: Group J: non-hypertensive non-diabetic (n == I I); Group H: non-hypertensive diabetic (n "" 3 ); Group Ill: hypertensive nondiabetic (n = 8 )i Group IV: hypertensive diabetic (n = 6). There were no differences in blood pressure (BP), heart rate (HR), LVEF or leftventricular (LV) mass index between the groups. However, mean wall thickness and LV posterior wall thickness, in systole and diastole, were greater (p < 0.05) in hypertensive heart failure patients (Group III) than hypertensive hurt failure patient wilh diabetes (Group IV). Group IV (hypertensive, diabetic, heart failure) pr.tients were similar to Group 1patients in mean wall thickness and LV poslerior wall thiclrness. PatiC!lts with hypertensive heart failure (Group III) alsoexhibited :10 increase in mitl'lll "A" velocity (p < 0.04), which was not 5CCn in the other groups. Statistically there was no differences in peak "E" velocity, intraventricular relaxation time (fVRT), Dr cr WE":"A" ratio suggesting similar LVpreload among the groups. Length and leftventricular internal dimension - diastole (LVIDO) were nO" j~hanged among the groups. Conclusion: Hypertensive heart failure is associated withdifferent LV wall thicknesr and diastolic flow pattern than heart failure wilh diabetes mell itusand no hypertension. The presence of diabetes mellitus pili:'; I:ypertension produces wall thickness similar 10 dilated cardiomyopaihj' due 10 other causes.

Heart Rote Variobil ity Par_ters All: S'./B

PIll: SY8

AI(

to PM

(lllIJ

Group' Group 2

'.811 .2 1.6 1 0.3 2.2 1 0.6 1.91 1.2

2.711. 4* 0.0910.12+ 1.6 1 1.0 -0.03 1 0.11 Group 3 2.0 1 -0.03 1 0.15 Group 4 1.710.8 0,0310.12 * P :!i 0.05 (change frcxn AM SVBI, t P :!i D.DS

'.2

SO)

ClIC HI HZ AI(

to PM (WJ

·0.0510.03+ 0.04 1 0.'0 0.04 1 0.07 0.0210.09

Conclusion: In the non-hypertensive, non-diabetic patient, advanced CHF, despite standard treatment, results in an abnormal nighttime increase in SVB dueto an increase in sympathetic activity. Assoclated hypertension and diabetes mellitus nallen the curve wilh an abnormal SVB characterized by the Jack of a circadian shift. The increase in nocturnal sympathetic tonemay predispose 10 arrhylhmi.tS. Thus these differences in autonomic tone may influence outcome and treatment stralegies in patients with advanced CHF.

Ke}' Words: cardi omYOpn thy. hypertension.

diabetes, [CliO

(lIIl!BIl i

CNG LOll ;;Z

Key Words:

heart rate variabi 1i ty , power spectral analysis