de Simone Giovanni, Izzo Raffaele, Losi Maria Angela, Stabile Eugenio, Rozza Francesco, Canciello Grazia, Mancusi Costantino, Trimarco Valentina, De Luca Nicola, Trimarco Bruno
aHypertension Research Center bDepartment of Advanced Translational Medical Sciences cDepartment of Biomedical Sciences dDepartment of Neurosciences, Federico II University Hospital, Napoli, Italy.
J Hypertens. 2016 Sep;34(9):1846-53. doi: 10.1097/HJH.0000000000001007.
Myocardial mechano-energetic efficiency (MEE) can be easily approximated by the ratio of stroke work [i.e. SBP times stroke volume (SV)] to a rough estimate of energy consumption, the 'double product' [SBP times heart rate (HR)], which can be simplified as SV/HR. We evaluated whether MEE is associated with adverse prognosis in relation to the presence of left ventricular hypertrophy (LVH).
Hypertensive participants of the Campania Salute Network (n = 12 353) without prevalent coronary or cerebrovascular disease and with ejection fraction more than 50% were cross-sectionally and longitudinally analyzed, over a median follow-up of 31 months. MEE was estimated by echocardiographic SV (z-derived)/(HR × 0.6).
Due to the close relation with left ventricular mass (LVM) (P < 0.0001), MEE was normalized for LVM (MEEi) and divided into quartiles. The lowest quartile of MEEi (<0.29 ml/s per g) was considered 'low MEEi'. MEEi was greater in women than in men (P < 0.0001). Progressively lower MEEi was associated with older age, male sex, obesity, diabetes, LVH, concentric geometry, inappropriate LVM and diastolic dysfunction, more use of antihypertensive therapy, and higher BP (all P < 0.002). In Cox regression, after controlling for LVH, age, sex, and average follow-up SBP, low MEEi exhibited increased hazard of composite fatal and nonfatal cardiovascular end-points (P < 0.01), independently of antihypertensive therapy and associated cardiovascular risk factors.
A simple estimate of low myocardial mechano-energetic efficiency is associated with altered metabolic profile, LVH, concentric left ventricular geometry, and diastolic dysfunction and predicts cardiovascular end-points, independently of age, sex, LVH antihypertensive therapy, and cardiovascular risk factors.
心肌机械能量效率（MEE）可通过每搏功[即收缩压（SBP）乘以每搏量（SV）]与能量消耗粗略估计值“双乘积”[SBP乘以心率（HR）]的比值轻松估算，该比值可简化为SV/HR。我们评估了MEE与左心室肥厚（LVH）存在情况下不良预后是否相关。
对坎帕尼亚健康网络中无冠心病或脑血管疾病且射血分数大于50%的高血压参与者（n = 12353）进行横断面和纵向分析，中位随访时间为31个月。通过超声心动图SV（z衍生值）/（HR×0.6）估算MEE。
由于与左心室质量（LVM）密切相关（P < 0.0001），对MEE进行LVM标准化（MEEi）并分为四分位数。MEEi最低四分位数（<0.29 ml/s per g）被视为“低MEEi”。女性的MEEi高于男性（P < 0.0001）。MEEi逐渐降低与年龄较大、男性、肥胖、糖尿病、LVH、向心性几何形态、不适当的LVM和舒张功能障碍、更多使用抗高血压治疗以及更高的血压相关（均P < 0.002）。在Cox回归分析中，在控制LVH、年龄、性别和随访期间平均收缩压后，低MEEi显示出复合致命和非致命心血管终点风险增加（P < 0.01），独立于抗高血压治疗和相关心血管危险因素。
心肌机械能量效率低下的简单估计与代谢状况改变、LVH、向心性左心室几何形态和舒张功能障碍相关，并可预测心血管终点，独立于年龄、性别、LVH、抗高血压治疗和心血管危险因素。
