Reduced global longitudinal strain at rest and inadequate blood pressure response during exercise treadmill testing in male heterozygous familial hypercholesterolemia patients

Vasiliki Vartela; Iakovos Armenis; Dimitra Leivadarou; Konstantinos Toutouzas; Konstantinos Makrilakis; George D Athanassopoulos; George Karatasakis; Genovefa Kolovou; Sophia Mavrogeni; Despina Perrea

doi:10.1016/j.ijchy.2021.100083

Reduced global longitudinal strain at rest and inadequate blood pressure response during exercise treadmill testing in male heterozygous familial hypercholesterolemia patients

Int J Cardiol Hypertens. 2021 Apr 20:9:100083. doi: 10.1016/j.ijchy.2021.100083. eCollection 2021 Jun.

Authors

Affiliations

¹ Onassis Cardiac Surgery Center, Department of Cardiology, Athens, Greece.
² Harokopio University, Athens, Greece.
³ National and Kapodistrian University of Athens, Medical School, Greece.
⁴ Hippokration Hospital, First Department of Cardiology, National and Kapodistrian University of Athens, Medical School, Greece.
⁵ Internal Medicine, National and Kapodistrian University of Athens Medical School, Greece.
⁶ Hellenic Diabetes Association, Athens, Greece.
⁷ Laikon Hospital, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens Medical School, Athens, Greece.
⁸ Metropolitan Hospital, Athens, Greece.
⁹ National and Kapodistrian University of Athens, Division of Experimental Surgery, Greece.

Abstract

Background: Heterozygous familial hypercholesterolemia (heFH) is a genetic disorder leading to premature coronary artery disease (CAD). We hypothesized that the subclinical pathophysiologic consequences of hypercholesterolemia may be detected before the occurrence of clinically overt CAD by stress testing and myocardial strain imaging.

Patients-methods: We evaluated the treadmill tests (ETTs) of 46 heFH men without known arterial hypertension/diabetes mellitus/vasculopathy like CAD and of 39 healthy men matched for age, baseline systolic/diastolic blood pressure (BP) and heart rate (HR), using Bruce protocol. Global longitudinal strain (GLS) of the left ventricle (LV) additionally to ejection fraction was obtained.

Results: heFH men reached a significantly higher peak systolic and diastolic BP compared to controls (p = 0.002 and p < 0.001, respectively). Mean rate pressure product was significantly higher in heFH patients (p = 0.038). Both duration of the ETT and workload in metabolic equivalents was lower in the heFH group (p < 0.001 and p < 0.001, respectively). Baseline to peak rise of systolic and diastolic BP in heFH men was higher (p = 0.008 and p < 0.001 for systolic and diastolic BP, respectively). Furthermore, heFH men had higher rise of HR from baseline to peak, compared to controls; (p = 0.047). GLS in heHF men was slightly decreased (p = 0.014), although the ejection fraction was similar in both groups.

Conclusion: heFH men have a higher rise in systolic/diastolic BP during ETT, which may reflect early, preclinical hypertension. Furthermore, slight impairment of LV GLS is present, despite the absence of apparent myocardial dysfunction in conventional 2D echocardiography.

Keywords: Arterial blood pressure; BP, blood pressure; CAD, coronary artery disease; Coronary artery disease; DBP, diastolic blood pressure; EDV, end-diastolic volume; ESV, end-systolic volume; ETT, Exercise treadmill test; Exercise treadmill test; FH, Familial hypercholesterolemia; GLS, Global longitudinal strain; Global longitudinal strain; HDL, high density lipoprotein; HR, heart rate; Heterozygous familial hypercholesterolemia; LDL, low-density lipoprotein; LV, left ventricle; LVEF, LV ejection fraction; METs, metabolic equivalents; RPP, rate pressure product; SBP, systolic blood pressure; TC, total cholesterol; TG, triglyceride; heFH, heterozygous familial hypercholesterolemia; hoFH, homozygous familial hypercholesterolemia.