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Hypertension: HELP
Articles by Thomas Hugh Marwick
Based on 35 articles published since 2010
(Why 35 articles?)
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Between 2010 and 2020, T. Marwick wrote the following 35 articles about Hypertension.
 
+ Citations + Abstracts
Pages: 1 · 2
1 Editorial Arterial Loading and the Prevention of Atrial Dysfunction. 2017

Marwick, Thomas H / Sharman, James E. ·From the Baker Heart and Diabetes Institute, Melbourne, Australia (T.H.M.) · and Menzies Institute for Medical Research, Hobart, Australia (J.E.S.). ·Circ Cardiovasc Imaging · Pubmed #28592594.

ABSTRACT: -- No abstract --

2 Editorial Impaired Right Heart and Pulmonary Vascular Function in HFpEF: Time for More Risk Markers? 2017

Kaye, David M / Marwick, Thomas H. ·Heart Failure Research Group, Baker IDI Heart and Diabetes Research Institute, Alfred Hospital, Melbourne, Australia. Electronic address: david.kaye@bakeridi.edu.au. · Heart Failure Research Group, Baker IDI Heart and Diabetes Research Institute, Alfred Hospital, Melbourne, Australia. ·JACC Cardiovasc Imaging · Pubmed #28412416.

ABSTRACT: -- No abstract --

3 Editorial The Strain of Detecting Early Target Organ Damage in Hypertension. 2015

Marwick, Thomas H / Venn, Alison J. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: tom.marwick@utas.edu.au. · Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. ·J Am Coll Cardiol · Pubmed #26112190.

ABSTRACT: -- No abstract --

4 Review Resting and Exercise Doppler Hemodynamics: How and Why? 2019

Nanayakkara, Shane / Kaye, David M / Marwick, Thomas H. ·Department of Cardiology, The Alfred, 55 Commercial Road, Melbourne, Victoria 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia; Department of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia. Electronic address: shane.nanayakkara@baker.edu.au. · Department of Cardiology, The Alfred, 55 Commercial Road, Melbourne, Victoria 3004, Australia; Heart Failure Research Laboratory, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia. · Department of Cardiology, The Alfred, 55 Commercial Road, Melbourne, Victoria 3004, Australia; Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia. ·Heart Fail Clin · Pubmed #30832814.

ABSTRACT: Exercise intolerance is the clinical hallmark of the failing heart. Evidence of hemodynamic derangement is not always present at rest, often necessitating dynamic challenges to accentuate abnormalities. Although cardiac catheterization, particularly with exercise, remains the gold standard method for hemodynamic assessment, it is limited by practicality, access, risk, and its invasive nature; consequently, there is a need to better understand noninvasive measures. Echocardiography and cardiac MRI offer promising modalities to quantify ventriculo-vascular interactions. Significant heterogeneity exists around exercise protocols, and there is a need to develop consensus methodology and to validate these noninvasive measures in all forms of heart failure.

5 Review Follow-Up of Pulmonary Hypertension With Echocardiography. 2016

Wright, Leah M / Dwyer, Nathan / Celermajer, David / Kritharides, Len / Marwick, Thomas H. ·Menzies Institute for Medical Research, Hobart, Australia; Royal Hobart Hospital, Hobart, Australia; Baker-IDI Heart and Diabetes Institute, Melbourne, Australia. · Royal Hobart Hospital, Hobart, Australia. · University of Sydney, Sydney, Australia. · Menzies Institute for Medical Research, Hobart, Australia; Royal Hobart Hospital, Hobart, Australia; Baker-IDI Heart and Diabetes Institute, Melbourne, Australia. Electronic address: Tom.Marwick@utas.edu.au. ·JACC Cardiovasc Imaging · Pubmed #27282440.

ABSTRACT: Individual patient response to effective therapies for pulmonary hypertension (PAH) is variable and difficult to quantify. Consequently, management decisions regarding initiation and continuation of therapy are highly dependent on the results of investigations. Registry data show that changes in cardiac index, mean right atrial pressure, and mean pulmonary artery pressure have the greatest influence on survival. It is recognized that pulmonary artery pressure (PASP) responses to PAH-specific drugs are heterogeneous. However, follow-up testing is strongly focused on assessing changes in PASP and functional status (6-min walk). The goals of therapy, which should be highlighted in follow-up imaging, include not only reduction of PASP, decrease in pulmonary vascular resistance, and improvements in right ventricular function, cardiac output, and tricuspid regurgitation. This paper reviews the echocardiographic follow-up of pulmonary hypertension, and especially focuses on right ventricular function-a major determinant of outcome, for which reliable echocardiographic assessment has become more feasible.

6 Review Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). 2015

Marwick, Thomas H / Gillebert, Thierry C / Aurigemma, Gerard / Chirinos, Julio / Derumeaux, Genevieve / Galderisi, Maurizio / Gottdiener, John / Haluska, Brian / Ofili, Elizabeth / Segers, Patrick / Senior, Roxy / Tapp, Robyn J / Zamorano, Jose L. ·Menzies Research Institute Tasmania, Hobart, Australia. · University of Ghent, Ghent, Belgium. · University of Massachusetts, Worcester, MA, USA. · University of Pennsylvania, Philadelphia, PA, USA. · Université Claude Bernard Lyon, Villeurbanne, France. · Federico II University Hospital, Naples, Italy. · University of Maryland, College Park, MD, USA. · University of Queensland, Brisbane, Australia. · Moorhouse University, Washington, DC, USA. · Biomedical Research Unit, Imperial College, London, UK; Royal Brompton Hospital, London, UK. · University of Melbourne, Melbourne, Australia. · University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain. ·J Am Soc Echocardiogr · Pubmed #26140936.

ABSTRACT: Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.

7 Review Recommendations on the use of echocardiography in adult hypertension: a report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE)†. 2015

Marwick, Thomas H / Gillebert, Thierry C / Aurigemma, Gerard / Chirinos, Julio / Derumeaux, Genevieve / Galderisi, Maurizio / Gottdiener, John / Haluska, Brian / Ofili, Elizabeth / Segers, Patrick / Senior, Roxy / Tapp, Robyn J / Zamorano, Jose L. ·Menzies Research Institute Tasmania, Hobart, Australia. · University of Ghent, Ghent, Belgium. · University of Massachusetts, Worcester, MA, USA. · University of Pennsylvania, Philadelphia, PA, USA. · Université Claude Bernard Lyon, Villeurbanne, France. · Federico II University Hospital, Naples, Italy. · University of Maryland, College Park, MD, USA. · University of Queensland, Brisbane, Australia. · Moorhouse University, Washington, DC, USA. · Biomedical Research Unit, Imperial College, London, UK Royal Brompton Hospital, London, UK. · University of Melbourne, Melbourne, Australia. · University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain zamorano@secardiologia.es. ·Eur Heart J Cardiovasc Imaging · Pubmed #25995329.

ABSTRACT: Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.

8 Review Exercise-induced hypertension, cardiovascular events, and mortality in patients undergoing exercise stress testing: a systematic review and meta-analysis. 2013

Schultz, Martin G / Otahal, Petr / Cleland, Verity J / Blizzard, Leigh / Marwick, Thomas H / Sharman, James E. ·Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia. ·Am J Hypertens · Pubmed #23382486.

ABSTRACT: BACKGROUND: The prognostic relevance of a hypertensive response to exercise (HRE) is ill-defined in individuals undergoing exercise stress testing. The study described here was intended to provide a systematic review and meta-analysis of published literature to determine the value of exercise-related blood pressure (BP) (independent of office BP) for predicting cardiovascular (CV) events and mortality. METHODS: Online databases were searched for published longitudinal studies reporting exercise-related BP and CV events and mortality rates. RESULTS: We identified for review 12 longitudinal studies with a total of 46,314 individuals without significant coronary artery disease, with total CV event and mortality rates recorded over a mean follow-up of 15.2±4.0 years. After adjustment for age, office BP, and CV risk factors, an HRE at moderate exercise intensity carried a 36% greater rate of CV events and mortality (95% CI, 1.02-1.83, P = 0.039) than that of subjects without an HRE. Additionally, each 10mm Hg increase in systolic BP during exercise at moderate intensity was accompanied by a 4% increase in CV events and mortality, independent of office BP, age, or CV risk factors (95% CI, 1.01-1.07, P = 0.02). Systolic BP at maximal workload was not significantly associated with the outcome of an increased rate of CV, whether analyzed as a categorical (HR=1.49, 95% CI, 0.90-2.46, P = 0.12) or a continuous (HR=1.01, 95% CI, 0.98-1.04, P = 0.53) variable. CONCLUSIONS: An HRE at moderate exercise intensity during exercise stress testing is an independent risk factor for CV events and mortality. This highlights the need to determine underlying pathophysiological mechanisms of exercise-induced hypertension.

9 Review Arterial stiffness: measurement and significance in management of hypertension. 2010

Sharman, James E / Marwick, Thomas H. ·Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia. James.Sharman@utas.edu.au ·Indian Heart J · Pubmed #23189876.

ABSTRACT: Hypertension is accompanied by generalized adverse vascular functional and structural changes including increased large central artery stiffness. Aortic pulse wave velocity (PWV) is a measure of regional large artery stiffness regarded as the gold standard by expert consensus. Elevated aortic PWV imposes additional left ventricular (LV) workload through increased impedance to flow, and independently correlates with LV systolic and diastolic function, as well as cardiovascular mortality. Traditional antihypertensive drugs do not specifically target wall stiffness of the central arteries, but nonetheless may achieve a decline in aortic PWV by reducing mean arterial pressure and unloading the vessel wall. Beyond medication, regular aerobic exercise combined with sodium restricted diet (such as that advocated by the Dietary Approach to Stop Hypertension [DASH] diet) is probably the most effective way to counteract increased large central artery stiffness. This paper reviews the assessment and clinical implications of arterial stiffness in managing patients with hypertension.

10 Article Threshold of Pulmonary Hypertension Associated With Increased Mortality. 2019

Strange, Geoff / Stewart, Simon / Celermajer, David S / Prior, David / Scalia, Gregory M / Marwick, Thomas H / Gabbay, Eli / Ilton, Marcus / Joseph, Majo / Codde, Jim / Playford, David / Anonymous1900992. ·University of Notre Dame, Fremantle, Western Australia, Australia. Electronic address: gstrange@neda.net.au. · University of Cape Town, Cape Town, South Africa. · Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia. · University of Melbourne, St. Vincent's Hospital, Melbourne, Victoria, Australia. · University of Queensland, The Prince Charles Hospital, Brisbane, Queensland, Australia. · Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia. · University of Notre Dame, Fremantle, Western Australia, Australia. · Menzies School of Health Research, Royal Darwin Hospital, Tiwi, Northern Territory, Australia. · Flinders University, Adelaide, South Australia, Australia. ·J Am Coll Cardiol · Pubmed #31146810.

ABSTRACT: BACKGROUND: There is increasing evidence that current thresholds for diagnosing pulmonary hypertension (PHT) underestimate the prognostic impact of PHT. OBJECTIVES: The aim of this study was to determine the prognostic impact of increasing pulmonary pressures within the National Echocardiography Database of Australia cohort (n = 313,492). METHODS: The distribution of estimated right ventricular systolic pressure (eRVSP) was examined in 157,842 men and women. All had data linkage to long-term survival during median follow-up of 4.2 years (interquartile range: 2.2 to 7.5 years). RESULTS: The cohort comprised 74,405 men and 83,437 women 65.6 ± 17.7 years of age. Overall, 17,955 (11.4%), 7,016 (4.4%), and 4,515 (2.9%) subjects had eRVSP levels indicative of mild (40 to 49 mm Hg), moderate (50 to 59 mm Hg), or severe (≥60 mm Hg) PHT, respectively, assuming a right atrial pressure of 5 mm Hg. These subjects were more likely to die during long-term follow up (for severe PHT, adjusted hazard ratio: 9.73; 95% confidence interval: 8.60 to 11.0; p < 0.001). After adjustment for age, sex, and evidence of left heart disease, those subjects with eRVSP levels within the third (28.05 to 32.0 mm Hg; hazard ratio: 1.410; 95% confidence interval: 1.310 to 1.517) and fourth (32.05 to 38.83 mm Hg; hazard ratio: 1.979; 95% confidence interval: 1.853 to 2.114) quintiles had significantly higher mortality (p < 0.001) than those in the lowest quintile. Accordingly, a clear and consistent threshold of increased mortality (including 1- and 5-year actuarial mortality) around an eRVSP of 30.0 mm Hg was evident. CONCLUSIONS: In this large and unique cohort, the prognostic impact of clinically accepted levels of PHT was confirmed. Moreover, a distinctly lower threshold for increased risk for mortality (eRVSP >30.0 mm Hg) indicative of PHT was identified. (A Longitudinal Cohort Study of Echocardiograms From Public and Private Echocardiography Laboratories From Around Australia, Linked With the National Deaths Index; ACTRN12617001387314).

11 Article Relative Importance of Baseline and Longitudinal Evaluation in the Follow-Up of Vasodilator Therapy in Pulmonary Arterial Hypertension. 2019

Wright, Leah / Dwyer, Nathan / Wahi, Sudhir / Marwick, Thomas H. ·Menzies Institute for Medical Research, Hobart, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia. · Royal Hobart Hospital, Hobart, Australia. · Princess Alexandra Hospital, Brisbane, Australia. · Baker Heart and Diabetes Institute, Melbourne, Australia. Electronic address: tom.marwick@bakeridi.edu.au. ·JACC Cardiovasc Imaging · Pubmed #30343091.

ABSTRACT: OBJECTIVES: The aim of this study was to evaluate the relative value of baseline and follow-up echocardiographic assessment of pulmonary artery systolic pressure (PASP) and right ventricular (RV) function in assessing response to vasodilator therapy in pulmonary arterial hypertension (PAH). BACKGROUND: Routine follow-up of PASP and RV function is widely obtained in patients undergoing treatment for PAH, but the value of this reassessment is uncertain. METHODS: Of 162 prospectively recruited patients with PAH, 96 were included in this analysis of patients with ≥3 sequential echocardiographic studies. PASP and RV function (including right ventricular free wall strain [RVFWS]) were measured at baseline and on follow-up 2-dimensional echocardiography. Univariate and multivariate Cox regression with nested models was used to determine incremental and independent predictors of all-cause mortality. RESULTS: Changes between visits were minimal for all parameters (RVFWS, p = 0.46; RV end diastolic area, p = 0.48; tricuspid annular plane systolic excursion, p = 0.32; PASP, p = 0.66; right atrial area, p = 0.39; and inferior vena cava, p = 0.25). Over 3 years of follow-up, 29 patients died. Baseline RVFWS was an independent predictor of outcome (hazard ratio [HR]: 0.90; 95% confidence interval [CI]: 0.83 to 0.97; p = 0.007), incremental to PASP and other clinical covariates (C statistic = 0.74, p = 0.001). Those who died showed no differences in RVFWS (p = 0.50), PASP (p = 0.90), and tricuspid annular plane systolic excursion (p = 0.83) between visits. When baseline measures and follow-up time were accounted for, mean changes in RVFWS (HR: 0.78; 95% CI: 0.63 to 0.96; p = 0.002), right atrial area (HR: 1.20; 95% CI: 1.07 to 1.40; p = 0.003), and inferior vena cava (HR: 66.5; 95% CI: 8.5 to 520.5; p < 0.001) over follow-up were significant in predicting outcome. CONCLUSIONS: In PAH, baseline RV function (RVFWS) is a strong predictor of outcome, independent of PASP. Changes throughout therapy appear minimal, and only changes in RVFWS, inferior vena cava, size, and right atrial area were associated with outcome.

12 Article Relation of Functional Status to Risk of Development of Atrial Fibrillation. 2017

Ramkumar, Satish / Yang, Hong / Wang, Ying / Nolan, Mark / Negishi, Kazuaki / Sanders, Prashanthan / Marwick, Thomas Hugh. ·Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia. · Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. · University of Adelaide, Adelaide, Australia. · Baker IDI Heart and Diabetes Institute, Melbourne, Australia; School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. Electronic address: Tom.Marwick@bakeridi.edu.au. ·Am J Cardiol · Pubmed #27956001.

ABSTRACT: Identifying patients at risk is now important as there are demonstrable ways to alter disease progression which could potentially prevent atrial fibrillation (AF) and its complications. We sought whether impaired functional capacity was associated with risk of AF, independent of myocardial dysfunction. In this community-based study, asymptomatic participants aged ≥65 years were recruited if they had ≥1 risk factor (e.g., hypertension, diabetes mellitus, and obesity). Participants underwent baseline echocardiography (including measurement of myocardial mechanics) and six-minute walk test. The CHARGE-AF score was used to calculate 5-year risk of developing AF. Receiver operating characteristic curves were used to assess for independent risk factors for AF. A total of 607 patients (age 71 ± 5 years, men 47%) were studied at baseline and followed for at least 6 months. Patients in the higher AF risk groups were older and had increased rates of hypertension, diabetes mellitus, and ischemic heart disease (p <0.05). Greater AF risk was associated with lower exercise capacity, independent of lower mean global longitudinal strain, global circumferential strain, greater mean E/e' ratio, indexed left atrial volume and LV mass. Multivariate linear regression confirmed association of LV and functional capacity parameters with AF risk. Although functional capacity is impaired in AF, this association precedes the onset of AF. In conclusion, poor functional status is associated with AF risk, independent of LV function.

13 Article Stability of left ventricular longitudinal and circumferential deformation over time and standard loading conditions. 2017

Kosmala, Wojciech / Przewlocka-Kosmala, Monika / Sharman, James E / Schultz, Martin G / Marwick, Thomas H. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia. · Cardiology Department, Wroclaw Medical University, Wroclaw, Poland. · Baker-IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia. ·Eur Heart J Cardiovasc Imaging · Pubmed #27369851.

ABSTRACT: Aims: Load dependence is an important source of variation in left ventricular (LV) deformation. This impacts on the precision of information obtained from serial measurements. However, it is clinically important to distinguish actual myocardial dysfunction from changes associated with altered loading conditions. We sought to investigate the association of changes of loading parameters with changes in LV longitudinal (GLS) and circumferential (GCS) strains. Methods and results: Baseline and a 12-month follow-up 2D echocardiograms were performed in 191 Stage A heart failure patients with uncomplicated hypertension. These patients underwent simultaneous measurement of conventional and central blood pressures (BPs) and haemodynamic measurements by applanation tonometry. Significant, but weak correlations (r = 0.15-0.28) of LV strain parameters and their changes over the follow-up period were shown for the majority of LV afterload-associated variables, including central and brachial systolic, diastolic, and mean BPs; 24-h systolic and diastolic BPs; peak reservoir and excess pressures; central augmented pressure (CAP) and pulse pressure; augmentation index; and arterial elastance index (EaI). Central mean BP, EaI, and changes in CAP and EaI over follow-up were independent contributors to LV deformation in multivariable analysis. No improvement in the Bland-Altman 95% limits of agreement and correlation coefficients was seen with LV afterload correction of GLS and GCS using central BP indices. Conclusions: LV longitudinal and circumferential strains in a population without apparent heart disease is relatively insusceptible to changes in LV afterload within physiological range, which, therefore, seem unlikely to be a significant confounder in repeated GLS or GCS observations.

14 Article Echocardiographic screening for non-ischaemic stage B heart failure in the community. 2016

Yang, Hong / Negishi, Kazuaki / Wang, Ying / Nolan, Mark / Saito, Makoto / Marwick, Thomas H. ·Menzies Institute for Medical Research, Hobart, Tasmania, Australia. · Menzies Institute for Medical Research, Hobart, Tasmania, Australia. Tom.Marwick@bakeridi.edu.au. · Baker-IDI Heart and Diabetes Institute, Melbourne, Australia. Tom.Marwick@bakeridi.edu.au. ·Eur J Heart Fail · Pubmed #27813300.

ABSTRACT: AIMS: Incident heart failure (HF) continues to pose a common and serious problem. We sought to examine the value of echocardiographic predictors of new HF in a community-based elderly population at risk for HF, independent of and incremental to clinical evaluation. METHODS AND RESULTS: Asymptomatic patients ≥65 years old, with ≥1 HF risk factor (hypertension, type 2 diabetes, or obesity) were recruited from the community; patients with valve disease, reduced ejection fraction (EF), and atrial fibrillation (AF) were excluded. Patients underwent standard clinical evaluation including calculation of the Charlson co-morbidity score and a comprehensive echocardiography including global longitudinal strain (GLS). Functional capacity was assessed by 6 min walk test. New HF and cardiovascular death were assessed after a mean follow-up of 14 ± 4 months by three independent cardiologists using Framingham criteria. Of 410 subjects (median age 70 years; 48% men), the prevalence of stage B HF was 13% [by LV hypertrophy (LVH)], 12% (by abnormal E/e'), 33% (by impaired GLS), and 31% [by left atrial enlargement (LAE)]. New HF symptoms developed in 49, and 2 died of cardiovascular causes, giving an event rate of 104/1000 person-years. These patients were older (P = 0.012), had a higher Charlson co-morbidity score (P < 0.001), larger LV mass and left atrium, higher E/e', and lower GLS (P < 0.05). LAE, LVH, abnormal GLS, and E/e' were independent predictors of new HF. In sequential models, LV mass and GLS added incremental information to clinical parameters. GLS significantly reclassified individuals (P = 0.002), but no reclassification improvement was identified using LV mass index, E/e', and left atrial volume index. CONCLUSION: Echocardiographic assessment (especially GLS and LV mass) provides incremental value in predicting incident HF.

15 Article Alterations in regional myocardial deformation assessed by strain imaging in cardiac amyloidosis. 2016

Lo, Queenie / Haluska, Brian / Chia, Ee-May / Lin, Ming-Wei / Richards, David / Marwick, Thomas / Thomas, Liza. ·University of New South Wales, Sydney, NSW, Australia. · Princess Alexandra Hospital, University of Queensland, Brisbane, Qld, Australia. · Westmead Hospital, Sydney, NSW, Australia. · Liverpool Hospital, Sydney, NSW, Australia. · Menzies Institute, Hobart, TAS, Australia. · University of Sydney, Sydney, NSW, Australia. ·Echocardiography · Pubmed #27600102.

ABSTRACT: BACKGROUND: Cardiac amyloidosis results in increased left ventricular (LV) wall thickness and diastolic dysfunction (DD). Strain measurements using velocity vector imaging (VVI) may further characterize myocardial dysfunction. METHODS: A total of 43 AL amyloidosis patients were compared to age-matched normals and hypertensive patients (HT). Subgroup analysis within the amyloid group was performed based on LV wall thickness (≤14 mm, >14 mm) and diastolic dysfunction (DD) (Group 1: normal and impaired relaxation, Group 2: pseudonormal, Group 3: restrictive). LV strain (longitudinal, circumferential, and radial strain (S) and strain rate [Sr]) were measured using velocity vector imaging (VVI). RESULTS: Increased LV wall thickness and DD were observed in the amyloid group. Global longitudinal (-13.9±4.1% vs -16.7±3.8%; P=.002) and radial (27.4±13.4% vs 38.8±15.7%; P<.001) strain were lower in the amyloid group vs normal controls, while circumferential strain was similar. Segmental analysis demonstrated reduced mid- and basal segmental strain with relative sparing of apical segments in the amyloid group. Reduced longitudinal and radial strain, with preserved circumferential strain, were observed in patients with wall thickness >14 mm; however, circumferential strain was also altered when severe DD (restrictive filling) was present. CONCLUSION: Reduction in longitudinal and radial S and Sr was evident using VVI strain analysis in amyloidosis, with segmental heterogeneity in longitudinal S. There was relative preservation of circumferential strain, which was reduced only in patients with severe DD.

16 Article Prognostic Implications of LV Strain Risk Score in Asymptomatic Patients With Hypertensive Heart Disease. 2016

Saito, Makoto / Khan, Faisal / Stoklosa, Ted / Iannaccone, Andrea / Negishi, Kazuaki / Marwick, Thomas H. ·Menzies Institute for Medical Research, Hobart, Australia. · Royal Hobart Hospital, Hobart, Australia. · Menzies Institute for Medical Research, Hobart, Australia. Electronic address: tom.marwick@bakeridi.edu.au. ·JACC Cardiovasc Imaging · Pubmed #27344417.

ABSTRACT: OBJECTIVES: This study sought to investigate the associations of left ventricular (LV) strain and its serial change with major adverse cardiac events (MACE) in hypertensive heart disease, independent of and incremental to clinical and LV geometric parameters. BACKGROUND: In patients with hypertensive heart disease, MACE are associated with abnormal LV morphology, but their association with subclinical LV dysfunction is unclear. METHODS: We retrospectively studied 388 asymptomatic nonischemic patients with hypertension who had abnormal LV geometry at a baseline echocardiogram between 2005 and 2014. Global longitudinal strain (GLS) was measured using speckle tracking. Patients were followed for MACE (death and admission because of heart failure, myocardial infarction, and strokes) over median of 4 years. A Cox proportional hazards model was used to assess the association of parameters with MACE. RESULTS: MACE (n = 72; 19%) were associated with higher prevalence of concentric hypertrophy and impaired GLS (both, p < 0.01). The association of GLS with MACE was independent of and incremental to clinical parameters and concentric hypertrophy. Echocardiographic follow-up was performed in 55 patients (median duration, 3 years); deterioration in GLS was also associated with the 10 patients experiencing MACE after the second echo. A risk score was developed using age >70, atrial fibrillation, concentric hypertrophy, and baseline GLS >-16% from the derivation cohort (C statistic, 0.71), and a separate validation cohort showed it to have good discrimination for MACE (C statistic, 0.71). CONCLUSIONS: GLS and its deterioration are associated with MACE in asymptomatic hypertensive heart disease. A risk score incorporating strain was useful for predicting risk of MACE.

17 Article Importance of Calibration Method in Central Blood Pressure for Cardiac Structural Abnormalities. 2016

Negishi, Kazuaki / Yang, Hong / Wang, Ying / Nolan, Mark T / Negishi, Tomoko / Pathan, Faraz / Marwick, Thomas H / Sharman, James E. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. Kazuaki.Negishi@utas.edu.au. · Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. ·Am J Hypertens · Pubmed #27085076.

ABSTRACT: BACKGROUND: Central blood pressure (CBP) independently predicts cardiovascular risk, but calibration methods may affect accuracy of central systolic blood pressure (CSBP). Standard central systolic blood pressure (Stan-CSBP) from peripheral waveforms is usually derived with calibration using brachial SBP and diastolic BP (DBP). However, calibration using oscillometric mean arterial pressure (MAP) and DBP (MAP-CSBP) is purported to provide more accurate representation of true invasive CSBP. This study sought to determine which derived CSBP could more accurately discriminate cardiac structural abnormalities. METHODS: A total of 349 community-based patients with risk factors (71±5years, 161 males) had CSBP measured by brachial oscillometry (Mobil-O-Graph, IEM GmbH, Stolberg, Germany) using 2 calibration methods: MAP-CSBP and Stan-CSBP. Left ventricular hypertrophy (LVH) and left atrial dilatation (LAD) were measured based on standard guidelines. RESULTS: MAP-CSBP was higher than Stan-CSBP (149±20 vs. 128±15mm Hg, P < 0.0001). Although they were modestly correlated (rho = 0.74, P < 0.001), the Bland-Altman plot demonstrated a large bias (21mm Hg) and limits of agreement (24mm Hg). In receiver operating characteristic (ROC) curve analyses, MAP-CSBP significantly better discriminated LVH compared with Stan-CSBP (area under the curve (AUC) 0.66 vs. 0.59, P = 0.0063) and brachial SBP (0.62, P = 0.027). Continuous net reclassification improvement (NRI) (P < 0.001) and integrated discrimination improvement (IDI) (P < 0.001) corroborated superior discrimination of LVH by MAP-CSBP. Similarly, MAP-CSBP better distinguished LAD than Stan-CSBP (AUC 0.63 vs. 0.56, P = 0.005) and conventional brachial SBP (0.58, P = 0.006), whereas Stan-CSBP provided no better discrimination than conventional brachial BP (P = 0.09). CONCLUSIONS: CSBP is calibration dependent and when oscillometric MAP and DBP are used, the derived CSBP is a better discriminator for cardiac structural abnormalities.

18 Article Right Ventricular Systolic Function Responses to Acute and Chronic Pulmonary Hypertension: Assessment with Myocardial Deformation. 2016

Wright, Leah / Dwyer, Nathan / Power, Janette / Kritharides, Leonard / Celermajer, David / Marwick, Thomas H. ·Menzies Institute for Medical Research, Hobart, Australia. · Royal Hobart Hospital, Hobart, Australia. · Concord Hospital, Sydney, Australia. · Royal Prince Alfred Hospital, Sydney, Australia. · Menzies Institute for Medical Research, Hobart, Australia; Royal Hobart Hospital, Hobart, Australia. Electronic address: tom.marwick@bakeridi.edu.au. ·J Am Soc Echocardiogr · Pubmed #26944627.

ABSTRACT: BACKGROUND: The distinction between right ventricular (RV) dysfunction due to an acute etiology (pulmonary embolism [PE]) or chronic afterload (pulmonary arterial hypertension [PAH]) has important therapeutic implications. The aim of this study was to test the hypothesis that RV remodeling would alter RV free wall strain (RVFWS) and differentiate chronic from acute RV afterload. METHODS: In this retrospective study, patients with PE (n = 45) who underwent echocardiography within 48 hours of computed tomographic pulmonary angiography were matched 1:1 for age, gender, and pulmonary artery systolic pressure with patients with PAH (n = 45) and a larger unmatched PAH control group (n = 116). RV function was evaluated with end-diastolic area, fractional area change (FAC), and RVFWS by two-dimensional speckle-tracking. The ability of RVFWS to distinguish acute from chronic RV dysfunction was assessed using receiver operating characteristic curves, and its incremental value was sought with stepwise models. RESULTS: RV end-diastolic area, FAC, and RVFWS were significantly impaired in patients with PE (P < .001), with no significant differences in other clinical variables. In matched patients, receiver operating characteristic curve analysis revealed that RVFWS had significantly better discriminative power than the McConnell sign (P = .02), with a cutoff of -17.9%, sensitivity of 87.5%, specificity of 62.5%, and an area under the curve of 0.76. Sequential logistic regression demonstrated an incremental and independent benefit of using RVFWS to predict acute PE versus chronic PAH (P = .01). Observer concordance was superior for RVFWS compared with FAC (P < .01). CONCLUSIONS: RVFWS is more predictive than RV end-diastolic area and less variable than FAC in distinguishing acute from chronic RV pressure overload. RVFWS adds incremental and independent information to standard measures of RV function in assessing the acuity of pulmonary hypertension.

19 Article Guiding Hypertension Management Using Central Blood Pressure: Effect of Medication Withdrawal on Left Ventricular Function. 2016

Kosmala, Wojciech / Marwick, Thomas H / Stanton, Tony / Abhayaratna, Walter P / Stowasser, Michael / Sharman, James E. ·Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Wroclaw Medical University, Wroclaw, Poland; · Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; · School of Medicine, Princess Alexandra Hospital, The University of Queensland, Brisbane, Australia; · Australia National University, Canberra, Australian Capital Territory, Australia. · Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; James.Sharman@menzies.utas.edu.au. ·Am J Hypertens · Pubmed #26152757.

ABSTRACT: BACKGROUND: Central blood pressure (BP) is an acknowledged contributor to end-organ damage and independent determinant of prognosis. Primary analysis from the BPGUIDE study demonstrated no detriment on left ventricular (LV) structure from central BP-guided hypertension management, despite significant medication withdrawal. However, the effect of this on LV function has not been investigated. In this study, we sought to investigate the impact of central BP-guided hypertension management on LV systolic and diastolic performance. METHODS: A total of 286 enrollees with uncomplicated hypertension were randomized to therapeutic decisions guided by best-practice usual care (UC) or, in addition, by central BP intervention (CBP) for 12 months. Each participant underwent baseline and follow-up 2-dimensional echocardiography, with assessment undertaken by an expert blinded to participant allocation. RESULTS: Antihypertensive medication quantity remained unchanged for UC but significantly decreased with intervention. However, no significant between-group differences were noted for changes during follow-up in both brachial and central BP, as well as other central hemodynamic parameters: augmentation index and augmented pressure. Similarly, there were no differences between groups in parameters of LV diastolic function: tissue e' velocity (∆UC vs. ∆CBP; P = 0.27) and E/e' ratio (∆UC vs. ∆CBP; P = 0.60), and systolic parameters: LV longitudinal strain (∆UC vs. ∆CBP; P = 0.55), circumferential strain (∆UC vs. ∆CBP; P = 0.79), and ejection fraction (∆UC vs. ∆CBP; P = 0.15). CONCLUSIONS: Hypertension management guided by central BP, resulting in significant withdrawal of medication to maintain appropriate BP control, had no adverse effect on LV systolic or diastolic function. Clinical trials registration: Australia New Zealand Clinical Trial Registry Number ACTRN12608 000041358.

20 Article Relationship between Right Ventricular Longitudinal Strain, Invasive Hemodynamics, and Functional Assessment in Pulmonary Arterial Hypertension. 2015

Park, Jae-Hyeong / Kusunose, Kenya / Kwon, Deborah H / Park, Margaret M / Erzurum, Serpil C / Thomas, James D / Grimm, Richard A / Griffin, Brian P / Marwick, Thomas H / Popović, Zoran B. ·Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA. ; Cardiology Division of Internal Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea. · Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA. ; Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan. · Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA. · Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA. ; Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA. · Department of Pathobiology, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA. ; Pulmonary and Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio, USA. · Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA. ; Menzies Research Institute, Tasmania, Australia. ·Korean Circ J · Pubmed #26413108.

ABSTRACT: BACKGROUND AND OBJECTIVES: Right ventricular longitudinal strain (RVLS) is a new parameter of RV function. We evaluated the relationship of RVLS by speckle-tracking echocardiography with functional and invasive parameters in pulmonary arterial hypertension (PAH) patients. SUBJECTS AND METHODS: Thirty four patients with World Health Organization group 1 PAH (29 females, mean age 45±13 years old). RVLS were analyzed with velocity vector imaging. RESULTS: Patients with advanced symptoms {New York Heart Association (NYHA) functional class III/IV} had impaired RVLS in global RV (RVLSglobal, -17±5 vs. -12±3%, p<0.01) and RV free wall (RVLSFW, -19±5 vs. -14±4%, p<0.01 to NYHA class I/II). Baseline RVLSglobal and RVLSFW showed significant correlation with 6-minute walking distance (r=-0.54 and r=-0.57, p<0.01 respectively) and logarithmic transformation of brain natriuretic peptide concentration (r=0.65 and r=0.65, p<0.01, respectively). These revealed significant correlations with cardiac index (r=-0.50 and r=-0.47, p<0.01, respectively) and pulmonary vascular resistance (PVR, r=0.45 and r=0.45, p=0.01, respectively). During a median follow-up of 33 months, 25 patients (74%) had follow-up examinations. Mean pulmonary arterial pressure (mPAP, 54±13 to 46±16 mmHg, p=0.03) and PVR (11±5 to 6±2 wood units, p<0.01) were significantly decreased with pulmonary vasodilator treatment. RVLSglobal (-12±5 to -16±5%, p<0.01) and RVLSFW (-14±5 to -18±5%, p<0.01) were significantly improved. The decrease of mPAP was significantly correlated with improvement of RVLSglobal (r=0.45, p<0.01) and RVLSFW (r=0.43, p<0.01). The PVR change demonstrated significant correlation with improvement of RVLSglobal (r=0.40, p<0.01). CONCLUSION: RVLS correlates with functional and invasive hemodynamic parameters in PAH patients. Decrease of mPAP and PVR as a result of treatment was associated with improvement of RVLS.

21 Article Exercise limitation associated with asymptomatic left ventricular impairment: analogy with stage B heart failure. 2015

Kosmala, Wojciech / Jellis, Christine L / Marwick, Thomas H. ·Cardiology Department, Wroclaw Medical University, Wroclaw, Poland; Menzies Medical Research Institute, University of Tasmania, Hobart, Australia. · Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio. · Menzies Medical Research Institute, University of Tasmania, Hobart, Australia. Electronic address: tom.marwick@utas.edu.au. ·J Am Coll Cardiol · Pubmed #25533754.

ABSTRACT: BACKGROUND: Stage B heart failure (SBHF) describes asymptomatic ventricular disease that may presage the development of heart failure (HF) symptoms. This entity has been largely defined by structural changes; the roles of sensitive indicators of nonischemic left ventricular (LV) dysfunction, such as LV strain, are undefined. OBJECTIVES: This study sought to define the association of exercise capacity with left ventricular hypertrophy (LVH) and systolic/diastolic dysfunction in asymptomatic patients with HF risk factors. METHODS: We used echocardiography to study 510 asymptomatic patients (age 58 ± 12 years) with type 2 diabetes mellitus, hypertension, or obesity. The results of cardiopulmonary exercise testing in patients with structural evidence of SBHF were compared with those in patients with subclinical dysfunction, defined by reduced LV strain (>-18%) or increased LV filling pressure (E/e' >13). RESULTS: Compared with healthy subjects, groups with LV abnormalities differed in terms of oxygen uptake (peak VO2): 25.5 ± 8.2 versus 21.0 ± 8.2 for strain >-18% (p < 0.001); 26.4 ± 8.0 versus 19.0 ± 7.2 for E/e' >13 (p < 0.0001); and 26.0 ± 7.7 versus 15.9 ± 6.9 ml/kg/min for LVH (p < 0.0001). SBHF, defined as ≥1 imaging variable present, was associated with lower peak VO2 (beta = -0.20; p < 0.0001) and metabolic equivalents (beta = -0.21; p < 0.0001), independent of higher body mass index and insulin resistance, older age, male sex, and treatment with beta-blockers. CONCLUSIONS: LVH, elevated LV filling pressure, and abnormal myocardial deformation were independently associated with impaired exercise capacity. Including functional markers may improve identification of SBHF in nonischemic heart disease.

22 Article Application of a parametric display of two-dimensional speckle-tracking longitudinal strain to improve the etiologic diagnosis of mild to moderate left ventricular hypertrophy. 2014

Phelan, Dermot / Thavendiranathan, Paaladinesh / Popovic, Zoran / Collier, Patrick / Griffin, Brian / Thomas, James D / Marwick, Thomas H. ·Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. · University of Toronto, Toronto, Ontario, Canada. · Menzies Research institute Tasmania, University of Tasmania, Hobart, Australia. Electronic address: tom.marwick@utas.edu.au. ·J Am Soc Echocardiogr · Pubmed #24874973.

ABSTRACT: BACKGROUND: The distinction of hypertrophic cardiomyopathy (HCM) or cardiac amyloidosis (CA) from hypertensive heart disease may be difficult. The aim of this study was to determine the impact of parametric (polar) maps of regional longitudinal strain on identification of the etiology of mild to moderate left ventricular hypertrophy (LVH). METHODS: Twenty-four consecutive echocardiographic studies with mild to moderate LVH (eight with CA, eight with HCM, and eight with hypertensive heart disease) were selected on the basis of the availability of adequate images to assess longitudinal strain and absence of electrocardiographic criteria for low voltage or LVH or a pseudoinfarct pattern. Twenty level 3-trained readers provided the most likely of three diagnoses (CA, HCM, or hypertensive heart disease) and scored their confidence in making the diagnosis from two-dimensional images and diastolic parameters. A teaching exercise was provided on the interpretation of longitudinal strain in these cohorts, and interpretation was repeated with the addition of the strain polar map. RESULTS: Baseline concordance among the readers was poor (κ = 0.28) and improved with the addition of strain data (κ = 0.57). Accuracy was improved with the addition of polar maps for the entire study cohort (P < .001), with 22% of cases reclassified correctly. The largest improvements in sensitivity (from 40% to 86%, P < .001), specificity (from 84% to 95%, P < .001), and accuracy (from 70% to 92%, P < .001) were seen for CA. The strain polar map significantly improved reader confidence in making the correct diagnosis overall (P < .001). CONCLUSIONS: Regional variations in strain are easily recognizable, accurate, and reproducible means of differentiating causes of LVH. The detection of LVH etiology may be a useful clinical application for strain.

23 Article Randomized trial of guiding hypertension management using central aortic blood pressure compared with best-practice care: principal findings of the BP GUIDE study. 2013

Sharman, James E / Marwick, Thomas H / Gilroy, Deborah / Otahal, Petr / Abhayaratna, Walter P / Stowasser, Michael / Anonymous3190770. ·Menzies Research Institute Tasmania, University of Tasmania, Private Bag 23, Hobart 7000, Australia. James.Sharman@menzies.utas.edu.au. ·Hypertension · Pubmed #24060891.

ABSTRACT: Arm cuff blood pressure (BP) may overestimate cardiovascular risk. Central aortic BP predicts mortality and could be a better method for patient management. We sought to determine the usefulness of central BP to guide hypertension management. This was a prospective, open-label, blinded-end point study in 286 patients with hypertension randomized to treatment decisions guided by best-practice usual care (n=142; using office, home, and 24-hour ambulatory BP) or, in addition, by central BP intervention (n=144; using SphygmoCor). Therapy was reviewed every 3 months for 12 months, and recommendations were provided to each patient and his/her doctor on antihypertensive medication titration. Outcome measures were as follows: medication quantity (daily defined dose), quality of life, and left ventricular mass (3-dimensional echocardiography). There was 92% compliance with recommendations on medication titration, and quality of life improved in both groups (post hoc P<0.05). For usual care, there was no change in daily defined dose (all P>0.10), but with intervention there was a significant stepwise decrease in daily defined dose from baseline to 3 months (P=0.008) and each subsequent visit (all P<0.001). Intervention was associated with cessation of medication in 23 (16%) patients versus 3 (2%) in usual care (P<0.001). Despite this, there were no differences between groups in left ventricular mass index, 24-hour ambulatory BP, home systolic BP, or aortic stiffness (all P>0.05). We conclude that guidance of hypertension management with central BP results in a significantly different therapeutic pathway than conventional cuff BP, with less use of medication to achieve BP control and no adverse effects on left ventricular mass, aortic stiffness, or quality of life.

24 Article Noninvasive assessment of pulmonary vascular resistance by Doppler echocardiography. 2013

Abbas, Amr E / Franey, Laura M / Marwick, Thomas / Maeder, Micha T / Kaye, David M / Vlahos, Antonios P / Serra, Walter / Al-Azizi, Karim / Schiller, Nelson B / Lester, Steven J. ·Department of Cardiology, Beaumont Health System, Royal Oak, Michigan; Oakland University/William Beaumont School of Medicine, Rochester, Michigan. · Department of Cardiology, Beaumont Health System, Royal Oak, Michigan. Electronic address: aabbas@beaumont.edu. · Menzies Research Institute of Tasmania, Hobart, Australia. · Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Heart Center, Alfred Hospital, Melbourne, Australia; Cardiology Division, Kantonsspital St. Gallen, St. Gallen, Switzerland. · Baker IDI Heart and Diabetes Institute, Melbourne, Australia; Heart Center, Alfred Hospital, Melbourne, Australia. · Pediatric Cardiology Division, University of Ioannina, Ioannina, Greece. · Cardiopulmonary Department, University Hospital, Parma, Italy. · Department of Internal Medicine, St. Joseph Mercy Oakland, Pontiac, Michigan. · University of San Francisco, San Francisco, California. · Division of Cardiovascular Diseases, Mayo Clinic, Scottsdale, Arizona. ·J Am Soc Echocardiogr · Pubmed #23860092.

ABSTRACT: BACKGROUND: The ratio of tricuspid regurgitation velocity (TRV) to the time-velocity integral of the right ventricular outflow tract (TVIRVOT) has been studied as a reliable measure to distinguish elevated from normal pulmonary vascular resistance (PVR). The equation TRV/TVIRVOT × 10 + 0.16 (PVRecho) has been shown to provide a good noninvasive estimate of PVR. However, its role in patients with significantly elevated PVR (> 6 Wood units [WU]) has not been conclusively evaluated. The aim of this study was to establish the validity of the TRV/TVIRVOT ratio as a correlate of PVR. The role of TRV/TVIRVOT was also compared with that of a new ratio, TRV(2)/TVIRVOT, in patients with markedly elevated PVR (>6 WU). METHODS: Data from five validation studies using TRV/TVIRVOT as an estimate of PVR were compared with invasive PVR measurements (PVRcath). Multiple linear regression analyses were generated between PVRcath and both TRV/TVIRVOT and TRV(2)/TVIRVOT. Both PVRecho and a new derived regression equation based on TRV(2)/TVIRVOT: 5.19 × TRV(2)/TVIRVOT - 0.4 (PVRecho2) were compared with PVRcath using Bland-Altman analysis. Logistic models were generated, and cutoff values for both TRV/TVIRVOT and TRV(2)/TVIRVOT were obtained to predict PVR > 6 WU. RESULTS: One hundred fifty patients remained in the final analysis. Linear regression analysis between PVRcath and TRV/TVIRVOT revealed a good correlation (r = 0.76, P < .0001, Z = 0.92). There was a better correlation between PVRcath and TRV(2)/TVIRVOT (r = 0.79, P < .0001, Z = -0.01) in the entire cohort as well as in patients with PVR > 6 WU. Moreover, PVRecho2 compared better with PVRcath than PVRecho using Bland-Altman analysis in the entire cohort and in patients with PVR > 6 WU. TRV(2)/TVIRVOT and TRV/TVIRVOT both predicted PVR > 6 WU with good sensitivity and specificity. CONCLUSIONS: TRV/TVIRVOT is a reliable method to identify patients with elevated PVR. In patients with TRV/TVIRVOT > 0.275, PVR is likely > 6 WU, and PVRecho2 derived from TRV(2)/TVIRVOT provides an improved noninvasive estimate of PVR compared with PVRecho.

25 Article Impact of spironolactone on vascular, myocardial, and functional parameters in untreated patients with a hypertensive response to exercise. 2013

Hare, James L / Sharman, James E / Leano, Rodel / Jenkins, Carly / Wright, Leah / Marwick, Thomas H. ·School of Medicine, The University of Queensland, Brisbane, Australia. ·Am J Hypertens · Pubmed #23412930.

ABSTRACT: BACKGROUND: Although a hypertensive response to exercise (HRE) is associated with cardiac risk and masked hypertension (MHT), its mechanisms and appropriate treatment remain unclear. We investigated spironolactone as a treatment for abnormal vascular and myocardial stiffness in HRE. METHODS: In this randomized, double-blind, placebo-controlled study of 115 patients (54 ± 9 years, 57% men) with an HRE (≥210/105 mm Hg in men; ≥190/105 mm Hg in women) but no prior history of hypertension or myocardial ischemia, MHT prevalence was 40%. Patients were randomized to spironolactone 25mg daily (n = 58) or placebo (n = 57) and underwent evaluation at baseline and 3 months with exercise echocardiography, VO2max, pulse wave velocity (PWV), exercise and central blood pressure (BP), and 24-hour ambulatory BP. Changes in left ventricular mass index (LVMI), Doppler-derived E/em ratio (LV filling pressure), and myocardial strain were assessed. RESULTS: Baseline 24-hour systolic BP (SBP) was 133 ± 10 mm Hg and peak-exercise SBP was 219 ± 16 mm Hg. Peak systolic strain (0.3 ± 3.6% vs. -0.1 ± 3.2, P = 0.56), E/em (-1.1 ± 2.3 vs. -0.6 ± 1.7, P = 0.30), VO(2max) (0.4 ± 4.9 vs. -0.9 ± 4.1 ml/kg/min, P = 0.15), and adjusted PWV did not significantly change with treatment, despite reduction in exercise SBP, 24-hour SBP, and LVMI. The change in exercise E/em was of borderline significance (-0.3 ± 2.4 vs. 0.8 ± 2.8, P = 0.06) and became significant after adjustment for baseline differences (P = 0.01). Patients with higher LVMI significantly increased VO(2max) (1.1 ± 5.6 vs. -2.4 ± 4.4 ml/kg/min, P < 0.05) and reduced exercise E/e(m) (-0.7 ± 2.7 vs. 1.9 ± 2.8, P < 0.05). CONCLUSIONS: In HRE patients without previous hypertension, short-term spironolactone reduced exercise BP, 24-hour ambulatory BP, LVMI, and E/e(m) but did not significantly alter exercise capacity or myocardial strain.

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