To access this material please log in or register

Register Authorize

Structure and function features and adverse prognostic factors of compensated hypertensive heart disease

Ovchinnikov A. G., Ozhereljeva M. V., Masenko V. P., Ageev F. T.
Federal State Budgetary Institution, "Russian Cardiology Science and Production Center" of the Ministry of Health of the Russian Federation, 3rd Cherepkovskaya 15a, Moscow 121552

Keywords: arterial hypertension, left ventricle hypertrophy, diastolic dysfunction of the left ventricle, systolic dysfunction of the left ventricle, heart failure with preserved ejection fraction

DOI: 10.18087/rhj.2017.3.2347

Background. Hypertensive heart disease is the major cause of heart failure with preserved ejection fraction (HF‑PEF). However, neither the incidence nor determinants of transition from asymptomatic LV hypertrophy (LVH) to HF‑PEF have been established so far. It is also unclear how often LV systolic dysfunction (SD) develops in these patients, and what mechanism underlies it. Aim. To evaluate structure and function features of the HF‑PEF course in patients with compensated hypertensive heart disease. Materials and methods. Based on archived documents, a cohort of 350 “sequential” patients was selected; these patients had been diagnosed with asymptomatic, concentric, hypertensive LVH and normal LV EF at their visit to the Science and Medicine Department of the A.L. Myasnikov Institute of Clinical Cardiology between 2002 and 2010. 223 patients returned for a revisit. Results. Median time between the first visit and the revisit was 8.1 years. During that time, 161 (72%) patients developed HF‑PEF whereas only 34 (15%) patients developed LV SD, including 18 (8%) cases caused by previous MI (“external” mechanism) and 16 (7%) cases resulting from long‑term pressure overload (“internal” mechanism). In the latter case, LV SD was slight and not associated with transition to eccentric LVH. Independent predictors of HF‑PEF included elderly age, LVH progression, and absence of the statin treatment; predictors of LV SD mediated by the “internal” mechanism included permanent atrial fibrillation and a high body mass index. Conclusion. Hypertensive heart disease very often results in HF‑PEF due to LV DD progression and the absence of statin treatment. In contrast, LV SD induced by long‑term pressure overload is an uncommon complication of hypertensive heart disease.
  1. Lavie CJ, Milani RV, Ventura HO, Messerli FH. Left ventricular geometry and mortality in patients >70 years of age with normal ejection fraction. Am J Cardiol. 2006;98(10):1396–9. DOI:10.1016/j.amjcard.2006.06.037.
  2. Gardin JM, McClelland R, Kitzman D, Lima JA, Bommer W, Klopfenstein HS et al. M‑mode echocardiographic predictors of six‑to seven‑year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study). Am J Cardiol. 2001;87(9):1051–7.
  3. Paulus WJ, Tschöpe C, Sanderson JE, Rusconi C, Flachskampf FA, Rademakers FE et al. How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J. 2007;28(20):2539–50. DOI:10.1093/eurheartj/ehm037.
  4. Lang R, Bierig M, Devereux R, Flachskampf F, Foster E, Pellikka P et al. Recommendations for chamber quantification. European Journal of Echocardiography. 2006;7(2):79–108. DOI:10.1016/j.euje.2005.12.014.
  5. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22(2):107–33. DOI:10.1016/j.echo.2008.11.023.
  6. Poli D, Antonucci E, Zanazzi M, Grifoni E, Testa S, Ageno W et al. Impact of glomerular filtration estimate on bleeding risk in very old patients treated with vitamin K antagonists. Results of EPICA study on the behalf of FCSA (Italian Federation of Anticoagulation Clinics). Thromb Haemost. 2012;107(6):1100–6. DOI:10.1160/TH11‑10‑0721.
  7. Hogg K, Swedberg K, McMurray J. Heart failure with preserve left ventricular systolic function; epidemiology, clinical characteristics, and prognosis. J Am Coll Cardiol. 2004;43(3):317–27. DOI:10.1016/j.jacc.2003.07.046.
  8. Paulus WJ, Tschöpe C. A novel paradigm for heart failure with preserved ejection fraction: comorbidities drive myocardial dysfunction and remodeling through coronary microvascular endothelial inflammation. J Am Coll Cardiol. 2013;62(4):263–71. DOI:10.1016/j.jacc.2013.02.092.
  9. van Heerebeek L, Hamdani N, Falcão‑Pires I, Leite‑Moreira AF, Begieneman MPV, Bronzwaer JGF et al. Low myocardial protein kinase G activity in heart failure with preserved ejection fraction. Circulation. 2012;126(7):830–9. DOI:10.1161/CIRCULATIONAHA.111.076075.
  10. Franssen C, Chen S, Unger A, Korkmaz HI, De Keulenaer GW, Tschöpe C et al. Myocardial Microvascular Inflammatory Endothelial Activation in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail. 2016;4(4):312–24. DOI:10.1016/j.jchf.2015.10.007.
  11. Ramasubbu K, Estep J, White DL, Deswal A, Mann DL. Experimental and clinical basis for the use of statins in patients with ischemic and nonischemic cardiomyopathy. J Am Coll Cardiol. 2008;51(4):415–26. DOI:10.1016/j.jacc.2007.10.009.
  12. Antoniades C, Bakogiannis C, Leeson P, Guzik TJ, Zhang M‑H, Tousoulis D et al. Rapid, direct effects of statin treatment on arterial redox state and nitric oxide bioavailability in human atherosclerosis via tetrahydrobiopterin‑mediated endothelial nitric oxide synthase coupling. Circulation. 2011;124(3):335–45. DOI:10.1161/CIRCULATIONAHA.110.985150.
  13. Fukuta H, Sane DC, Brucks S, Little WC. Statin therapy may be associated with lower mortality in patients with diastolic heart failure: a preliminary report. Circulation. 2005;112(3):357–63. DOI:10.1161/CIRCULATIONAHA.104.519876.
  14. Nochioka K, Sakata Y, Miyata S, Miura M, Takada T, Tadaki S et al. Prognostic impact of statin use in patients with heart failure and preserved ejection fraction. Circ J. 2015;79(3):574–82. DOI:10.1253/circj.CJ‑14‑0865.
  15. Alehagen U, Benson L, Edner M, Dahlström U, Lund LH. Association Between Use of Statins and Mortality in Patients With Heart Failure and Ejection Fraction of ≥50. Circ Heart Fail. 2015;8(5):862–70. DOI:10.1161/CIRCHEARTFAILURE.115.002143.
  16. Meerson FZ. Compensatory hyperfunction of the heart and cardiac insufficiency. Circ Res. 1962;10:250–8.
  17. Pfeffer JM, Pfeffer MA, Mirsky I, Braunwald E. Regression of left ventricular hypertrophy and prevention of left ventricular dysfunction by captopril in the spontaneously hypertensive rat. Proc Natl Acad Sci USA. 1982;79(10):3310–4.
  18. Molkentin JD, Lu JR, Antos CL, Markham B, Richardson J, Robbins J et al. A calcineurin‑dependent transcriptional pathway for cardiac hypertrophy. Cell. 1998;93(2):215–28.
  19. Cho G‑Y, Marwick TH, Kim H‑S, Kim M‑K, Hong K‑S, Oh D‑J. Global 2‑dimensional strain as a new prognosticator in patients with heart failure. J Am Coll Cardiol. 2009;54(7):618–24. DOI:10.1016/j.jacc.2009.04.061.
  20. Wang J, Khoury DS, Yue Y, Torre‑Amione G, Nagueh SF. Preserved left ventricular twist and circumferential deformation, but depressed longitudinal and radial deformation in patients with diastolic heart failure. Eur Heart J. 2008;29(10):1283–9. DOI:10.1093/eurheartj/ehn141.
  21. Drazner MH, Rame JE, Marino EK, Gottdiener JS, Kitzman DW, Gardin JM et al. Increased left ventricular mass is a risk factor for the development of a depressed left ventricular ejection fraction within five years: the Cardiovascular Health Study. J Am Coll Cardiol. 2004;43(12):2207–15. DOI:10.1016/j.jacc.2003.11.064.
  22. Krishnamoorthy A, Brown T, Ayers CR, Gupta S, Rame JE, Patel PC et al. Progression from normal to reduced left ventricular ejection fraction in patients with concentric left ventricular hypertrophy after long‑term follow‑up. Am J Cardiol. 2011;108(7):997–1001. DOI:10.1016/j.amjcard.2011.05.037.
  23. Haass M, Kitzman DW, Anand IS, Miller A, Zile MR, Massie BM et al. Body mass index and adverse cardiovascular outcomes in heart failure patients with preserved ejection fraction: results from the Irbesartan in Heart Failure with Preserved Ejection Fraction (I‑PRESERVE) trial. Circ Heart Fail. 2011;4(3):324–31. DOI:10.1161/CIRCHEARTFAILURE.110.959890.
  24. Shenouda SM, Widlansky ME, Chen K, Xu G, Holbrook M, Tabit CE et al. Altered mitochondrial dynamics contributes to endothelial dysfunction in diabetes mellitus. Circulation. 2011;124(4):444–53. DOI:10.1161/CIRCULATIONAHA.110.014506.
  25. Piccini JP, Hammill BG, Sinner MF, Jensen PN, Hernandez AF, Heckbert SR et al. Incidence and prevalence of atrial fibrillation and associated mortality among Medicare beneficiaries, 1993‑2007. Circ Cardiovasc Qual Outcomes. 2012;5(1):85–93. DOI:10.1161/CIRCOUTCOMES.111.962688.
  26. Strait JB, Lakatta EG. Aging‑associated cardiovascular changes and their relationship to heart failure. Heart Fail Clin. 2012;8(1):143–64. DOI:10.1016/j.hfc.2011.08.011.
  27. Iwanaga Y, Nishi I, Furuichi S, Noguchi T, Sase K, Kihara Y et al. B‑type natriuretic peptide strongly reflects diastolic wall stress in patients with chronic heart failure: comparison between systolic and diastolic heart failure. J Am Coll Cardiol. 2006;47(4):742–8. DOI:10.1016/j.jacc.2005.11.030.
Ovchinnikov A. G., Ozhereljeva M. V., Masenko V. P., Ageev F. T. Structure and function features and adverse prognostic factors of compensated hypertensive heart disease. Russian Heart Journal. 2017;16 (3):185–196

To access this material please log in or register

Register Authorize
Ru En