Key result
Elevated baseline blood pressure and hypertensive responses during exercise significantly impaired myocardial work indices, reducing GWI and GCW and increasing GWW (p<0.05).
Why the study?
The impact of hypertension, left ventricular remodeling, and hypertensive responses to exercise on myocardial work indices remains underexplored.
Do hypertension, elevated baseline blood pressure, and left ventricular remodeling impair myocardial work indices in patients without known cardiovascular disease?
Observational (n=822)
No
Do hypertension, elevated baseline blood pressure, and left ventricular remodeling impair myocardial work indices in patients without known cardiovascular disease?
p-value: p=<0.05
Elevated baseline blood pressure, exercise-induced hypertensive responses, and concentric left ventricular hypertrophy independently impair myocardial work indices, highlighting early myocardial dysfunction prior to overt cardiovascular disease.
May signal early myocardial dysfunction in preclinical hypertension; challenges consensus on preserved work indices and leaves open prospective validation.
Background Hypertension is a leading risk factor for cardiovascular disease and can subtly affect myocardial function before clinical manifestation. Advanced myocardial mechanics, such as Myocardial Work (MW) indices—Global Work Efficiency (GWE), Global Work Index (GWI), Global Constructive Work (GCW), and Global Wasted Work (GWW)—offer sensitive measures of cardiac performance. The impact of hypertension left ventricular (LV) remodelling and hypertensive responses to exercise on these parameters remains underexplored. Aims This study aimed to: 1. Compare MW parameters between hypertensive and normotensive individuals; 2. Investigate the impact of elevated resting blood pressure (BP) and hypertensive response during exercise on myocardial function; 3. Assess the influence of left ventricular remodeling on MW indices. Methods We conducted a single-center study of 822 patients without known cardiovascular disease who underwent exercise echocardiography. Of these, 583 patients completed the test (achieving predicted METs >85%). Participants were stratified by hypertension status, baseline BP, exercise-induced hypertensive response and LV echocardiographic remodeling patterns, including concentric remodeling and concentric left ventricle hypertrophy (LVH). Results Hypertension did not limit test completion. Hypertensive patients had higher E/e′ and significantly lower GWI compared to normotensive individuals. Left ventricular remodeling patterns, except for concentric hypertrophy, did not significantly affect MW indices. Concentric hypertrophy was associated with higher GWW (p=0.022). The most significant determinants of MW parameters were elevated baseline (BP) and hypertensive responses during exercise (p<0.05). Multivariate analysis identified concentric LVH and elevated baseline BP as the sole independent predictor of impaired MW indices, significantly affecting GWI, GCW, and GWW. Conclusion Elevated baseline blood pressure and hypertensive responses during exercise significantly impair myocardial work, as evidenced by reductions inGWI and GCW and increases inGWW. Left ventricle remodeling also impacts myocardial efficiency by increasing wasted work. These findings underscore the importance of addressing blood pressure management to mitigate early myocardial dysfunction, even in the absence of overt cardiovascular disease.
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Carvalho et al. (2026) conducted an observational in Hypertension (n=822). Hypertension and elevated baseline blood pressure vs. Normotensive individuals was evaluated on Myocardial Work (MW) indices (p=<0.05). Elevated baseline blood pressure and hypertensive responses during exercise significantly impaired myocardial work indices, reducing GWI and GCW and increasing GWW (p<0.05).
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