Key result
Isometric exercise is linked to ~18% lower global work efficiency in hypertensive ischemic heart disease.
Why the study?
The acute hemodynamic response to isometric exercise in hypertensive patients with ischemic heart disease had been poorly investigated.
Does acute isometric exercise cause maladaptive changes in myocardial work and hemodynamics in hypertensive patients with ischemic heart disease compared to healthy controls?
Case-Control (n=30)
No
Does acute isometric exercise cause maladaptive changes in myocardial work and hemodynamics in hypertensive patients with ischemic heart disease compared to healthy controls?
In hypertensive patients with ischemic heart disease, acute isometric exercise triggers significant increases in systolic blood pressure and left ventricular filling pressure, leading to an inefficient increase in myocardial work that fails to maintain stroke volume.
Suggests caution with isometric exercise in hypertensive IHD; hypothesis-generating and requires prospective validation before practice change.
Background: The acute hemodynamic response to isometric exercise in hypertensive patients’ ischemic heart disease (IHD) has been poorly investigated. The aim of this study was to assess acute changes in left ventricular myocardial work (MW) during isometric bilateral knee extension in patients with IHD. Methods: Twenty stable hypertensive patients with IHD and ten healthy, age-matched controls (HC) were enrolled. All subjects performed an isometric knee extension exercise at 30% of their maximal voluntary contraction. The effort was maintained for three minutes or until exhaustion. At baseline, at peak exercise, and after 10 min of recovery, echocardiography evaluation was performed and blood pressure (BP) and heart rate (HR) were measured. Results: The exercise was well tolerated by all subjects. At peak exercise, systolic BP in the IHD was significantly higher than HC (37.6 ± 7.2 vs. 8.4 ± 2.3 mmHg; p 0.002). The HC group had a greater increase in HR than IHD (19.7 ± 6.2 vs. 8.4 ± 2.2 bpm; p 0.009). The E/E′ ratio increased in IHD and was unchanged in the control group. The global work index increased significantly in IHD compared to HC (+15% vs. +3%; p 0.026). Global constructive work increased significantly in IHD compared to HC (+29.8% vs. +7.4 respectively, p 0.031). Global wasted work increased by 92.3% in IHD and was unchanged in HC. The global work efficiency decreased in IHD (−18%), but was unchanged in HC (between-groups p 0.019). Stroke volume decreased in IHD and was unchanged in HC. Cardiac output was unchanged in IHD, while it increased in HC. Conclusion: In patients with hypertension and underlying IHD, an acute isometric load causes a great increase in systolic BP and LV filling pressure. It follows a mostly ineffective increase in MW that fails to maintain stroke volume.
No takes yet. Share an insight, caveat, or question.
Caminiti et al. (2024) conducted a case-control in Hypertension with Ischemic Heart Disease (IHD) (n=30). Isometric bilateral knee extension exercise vs. Healthy age-matched controls performing the same exercise was evaluated on Change in global work efficiency (GWE) at peak exercise (p=0.019). During acute isometric knee extension, global work efficiency decreased by 18% in hypertensive patients with ischemic heart disease compared to being unchanged in healthy controls.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: