Dante Pazzanese Institute of Cardiology (IDPC), Sao Paulo, Brazil.
Echocardiography Department of InCor- A Heart Institute, University of São Paulo Medical School (USP), São Paulo, Brasil.
Echocardiography. 2022 Nov;39(11):1412-1419. doi: 10.1111/echo.15467. Epub 2022 Oct 10.
Individuals with resistant arterial hypertension are particularly at risk of developing target organ damage and cardiovascular events. The advanced echocardiography technique called myocardial work (MW), through the analysis of the left ventricular pressure-strain loop, is among the possibilities for evaluating these individuals. Our study was designed to describe the behavior of MW indices in individuals with resistant arterial hypertension (RH), controlled hypertension (CH), and normal arterial pressure (N).
Seventy-one patients underwent Ambulatory Blood Pressure Monitoring (ABPM) and were characterized into three groups after a medical consult: RH (subjects with hypertension on four or more antihypertensive medications despite having controlled blood pressure); CH (subjects with hypertension on up to two antihypertensive medications); and N (individuals with normal ABPM; not using any medications). Echocardiographic analysis was performed using the Vivid E95 ultrasound system and blood pressure was measured at the time of the examination and subsequently used to determine myocardial work indices. RH demonstrated lower global work efficiency (GWE, mean = .95%; p = .005) and higher global wasted work (GWW, mean = 114 mm Hg%; p = .011) compared to other groups. Left ventricular mass measured by three-dimensional echocardiography, systolic wall stress, relative wall thickness and peak systolic dispersion were inversely correlated to GWE. No difference was observed between CH and N groups regarding MW indices. On multivariate analysis, only systolic wall stress remained as an independent predictor of GWE, when controlled by 3D mass index, relative wall thickness, peak systolic dispersion, and the hypertension group.
Individuals with resistant hypertension have lower global work efficiency and higher global wasted work, compared to individuals with controlled hypertension and without arterial hypertension.
患有耐药性动脉高血压的个体尤其有发生靶器官损伤和心血管事件的风险。心肌做功（MW）是一种先进的超声心动图技术，通过分析左心室压力-应变环，可用于评估这些个体。我们的研究旨在描述耐药性动脉高血压（RH）、控制性高血压（CH）和正常动脉血压（N）个体的 MW 指数的行为。
71 名患者接受了动态血压监测（ABPM），并在接受医疗咨询后根据以下标准分为三组：RH（高血压患者服用四种或更多种降压药物，但血压控制良好）；CH（高血压患者服用最多两种降压药物）；和 N（ABPM 正常的个体；未使用任何药物）。使用 Vivid E95 超声系统进行超声心动图分析，并在检查时测量血压，随后用于确定心肌做功指数。与其他组相比，RH 的整体工作效率（GWE）较低（平均值为.95%；p=0.005），整体浪费功（GWW）较高（平均值为 114mmHg%；p=0.011）。由三维超声心动图测量的左心室质量、收缩壁应力、相对壁厚度和收缩期峰值离散度与 GWE 呈负相关。在 MW 指数方面，CH 和 N 组之间没有差异。在多变量分析中，当控制 3D 质量指数、相对壁厚度、收缩期峰值离散度和高血压组时，只有收缩壁应力仍然是 GWE 的独立预测因子。
与控制性高血压和无动脉高血压的个体相比，耐药性高血压个体的整体工作效率较低，整体浪费功较高。
