V.M. Kovalenko, Е.G. Nesukay, N.S. Polenova, E.Yu. Titov, O.O. DanylenkoRelationship of structural and functional state of left heart to exercise tolerance in patients with essential hypertension

The аim – to examine relation between structural, functional state of left heart and exercise tolerance (ET) in patients with essential hypertension (EH).
Material and methods. We enrolled 100 patients (men – 60 %) at age (55.5±0.5) years with EH. All patients were divided into 2 groups: A group – 36 patients without left ventricular hypertrophy (LVH), group B – 64 patients with LVH. Depending on the severity of LVH patients of group B were divided into 3 groups: B1 group – 24 patients with mild LVH, B2 group – 20 patients with moderate LVH and B3 – 20 patients with severe LVH. Echocardiography and speckle tracking echocardiography were performed in all patients. 70 patients (40 men and 30 women) underwent bicycle exercise stress test (BEST). The criterion of low ET in men was maximum oxygen uptake during BEST < 7 metabolic equivalents (MET) in men and < 5 MET in women. Control group consisted of 28 healthy individuals. Results. Global longitudinal systolic strain (GLSS) in A group was 6.0 % less than in control group. LVH was accompanied by deterioraton of left ventricular (LV) longitudinal and radial contraction geometry. Patients of B2 and B3 groups had less GLSS and GLSS rate compared to B1 group. In parallel with suppression of the longitudinal component of myocardial deformation we observed increase of the circumferential global systolic strain in B2 group by 12.8 % (Р<0.05) compared to the B1 group. Men with higher value of ET had 10 % higher GLSS compared to men with low ET. MET correlated with GLSS (r=0.35; Р<0.05) and magnitude of blood pressure increase during BEST was associated with LV mass. There was no relation of structural and functional state of LV and ET in women. Conclusions. Speckle tracking echocardiography enables diagnosis of myocardial dysfunction in patients with EH without LVH. In men aerobic activity was associated with longitudinal systolic deformation of LV.

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