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Minor ST-T changes on electrocardiograms are associated with reduced constructive myocardial work in hypertensive patients with a preserved ejection fraction

Hypertension Research volume 45, pages 1373–1381 (2022)Cite this article

Abstract

Minor ST-T changes on electrocardiograms are observed in patients with hypertensive heart disease with a preserved left ventricular ejection fraction (LVEF); however, the relationship between minor ST-T changes and global myocardial work on echocardiograms remains unclear. We evaluated the global longitudinal strain (GLS), global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) in 186 hypertensive patients with preserved LVEF (>50%) using an offline analysis system (View Pal, GE). Minor ST-T changes as well as major ST-T changes (depression in ST in lead V5 > 1 mV) were also evaluated by electrocardiography. The mean age was 79.4 ± 8.2 years (men 37.6%). Patients with minor and major ST-changes had a smaller absolute GLS (−20.3 ± 3.1, −18.2 ± 3.7, and −15.2 ± 5.0%, P < 0.001) and a smaller constructive workload [GWI (2148 ± 486, 1938 ± 462, and 1685 ± 701 mmHg%, P = 0.002) and GCW (2419 ± 510, 2185 ± 466, and 1865 ± 702 mmHg%, P < 0.001)] than those with no ST-T changes. Additionally, patients with minor and major ST-T changes had increased wasted myocardial work [GWW (87 ± 61, 105 ± 56, and 127 ± 75 mmHg%, P = 0.045)], which resulted in reductions in the myocardial work efficiency [GWE (95 ± 4, 94 ± 3, and 89 ± 12%, P < 0.001)]. Even after adjustments for confounding factors, including EF, diastolic function parameters, LV hypertrophy, history of heart failure and atrial fibrillation, patients with minor ST-T changes had significantly smaller LV global constructive work in comparison to those without [GWI (2260 ± 33 vs. 2025 ± 76 mmHg%, P = 0.007) and GCW (2501 ± 45 vs. 2210 ± 105 mmHg%, P = 0.003)]. In conclusion, in hypertensive patients with preserved LVEF, minor ST-T changes on electrocardiograms were associated with reduced constructive work in the LV.

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Acknowledgements

The first author currently belongs to the Department of Cardiology, Tokyo Metropolitan Tama Medical Center (Tokyo, Japan).

Funding

This study was supported in part by a grant from the Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology. The corresponding author (JI) was supported in part by a research grant from Tokyo Metropolitan Geriatric Hospital.

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Authors and Affiliations

  1. Department of Cardiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan

    Saori Nakamura, Joji Ishikawa, Ruri Shimizu, Ayumi Toba, Aya Yamamoto, Teppei Murata & Kazumasa Harada

  2. Department of Clinical Laboratory, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan

    Chieko Sakurayama

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  1. Saori Nakamura
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  2. Joji Ishikawa
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Correspondence to Joji Ishikawa.

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Nakamura, S., Ishikawa, J., Sakurayama, C. et al. Minor ST-T changes on electrocardiograms are associated with reduced constructive myocardial work in hypertensive patients with a preserved ejection fraction. Hypertens Res 45, 1373–1381 (2022). https://doi.org/10.1038/s41440-022-00957-6

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