Yalçin Fatih, Cagatay Boran, Abraham M Roselle, Garcia Mario J
Department of Cardiology, UCSF HEALTH, School of Medicine, Cardiac Imaging, San Francisco, CA 94158, USA.
Cardiology Division, Montefiore Einstein Center for Heart and Vascular Care, Bronx, NY 10461, USA.
J Clin Med. 2025 Aug 30;14(17):6143. doi: 10.3390/jcm14176143.
The interventricular septum is recognized as the first region to undergo remodeling, and a septal bulge is described as an early echocardiographic sign of hypertensive heart disease. Using third-generation microscopic ultrasonography in an animal model, we validated, for the first time, that remodeling originates in the basal septum, presenting as basal septal hypertrophy (BSH), an early imaging biomarker, and subsequently progresses to other regions, leading to tissue dysfunction and heart failure. We have termed this finding the "stress septal sign" (Triple S) because a variety of stress stimuli, such as treadmill exercise or pressure overload from aortic banding in animals, induced BSH, a region with more intensive sympathetic innervation than the mid-apex. This finding also represents a conjunctive point between functional etiologies, such as hypertension, and emotional etiologies that precipitate acute stress cardiomyopathy. Microscopic analysis of the remodeling revealed that hemodynamic stress has a specific effect on cardiac geometry. The Triple S is associated with exercise-induced hypertension and high stress scores in patients with hypertension. Furthermore, three-dimensional segmental remodeling is more effective than cross-sectional measurements for detecting the impact of superimposed multiple stressors. A high-rate pressure product and blood pressure variability in patients exhibiting the Triple S should be managed comprehensively through an integrated approach to stress and hypertension to avoid high mortality in clinical practice. A precise etiologic evaluation of incidentally detected BSH may contribute to the early diagnosis of hypertensive disease. The integrated and timely management of stress and hypertension is important for patients presenting with the Triple S and high stress scores. This management strategy may provide a practical solution for avoiding the adverse hypertensive consequences of global remodeling and maladaptation to superimposed multiple stressors.
室间隔被认为是第一个发生重塑的区域，室间隔膨出被描述为高血压性心脏病的早期超声心动图征象。在动物模型中使用第三代显微超声检查，我们首次验证了重塑起源于基底间隔，表现为基底间隔肥厚（BSH），这是一种早期成像生物标志物，随后进展至其他区域，导致组织功能障碍和心力衰竭。我们将这一发现称为“应激间隔征”（Triple S），因为多种应激刺激，如动物的跑步机运动或主动脉缩窄引起的压力过载，都会诱发BSH，该区域的交感神经支配比心尖中部更密集。这一发现还代表了功能性病因（如高血压）和引发急性应激性心肌病的情绪性病因之间的连接点。对重塑的微观分析表明，血流动力学应激对心脏几何形状有特定影响。Triple S与运动诱发的高血压以及高血压患者的高应激评分相关。此外，三维节段性重塑在检测叠加的多种应激源的影响方面比横截面测量更有效。对于表现出Triple S的患者，高心率压力乘积和血压变异性应通过综合的应激和高血压管理方法进行全面管理，以避免临床实践中的高死亡率。对偶然检测到的BSH进行精确的病因评估可能有助于高血压疾病的早期诊断。对于出现Triple S和高应激评分的患者，综合及时地管理应激和高血压很重要。这种管理策略可能为避免整体重塑和对叠加的多种应激源适应不良的不良高血压后果提供切实可行的解决方案。
