The associations of cardiac structure and function with blood pressure at rest and during exercise

doi:10.3877/cma.j.issn.2095-6568.2023.03.006

Abstract

Abstract:

Objective

To investigate whether exercise blood pressure (BP) was associated with cardiac structure and function independent of BP at rest.

Methods

In the outpatients who underwent non-invasive cardiac exercising test and echocardiography at The First Affiliated Hospital of Sun Yat-Sen University between January 2019 and October 2020, collected the clinical data and retrospectively assessed the association of cardiac structure (i.e., left atrial internal diameter, interventricular septal wall thickness, left ventricular posterior wall thickness), diastolic function [i.e., the peak early-diastolic (E) and peak end-diastolic (A) transmission velocity, the mean early-diastolic myocardial velocity (e')], and systolic function (left ventricular ejection fraction) with 1-SD increment in BP during exercise and at rest, using multivariable regression analyses.

Results

Among the 323 participants, age averaged (46.2±15.1) years. 40.2% (130/323) were men, and 13.6% (44/132) had coronary heart disease. With adjustments applied for gender, age, body mass index, coronary heart disease, and BP at rest, the association sizes with 1-SD increase in exercise systolic, and diastolic BP were 0.33 mm (P<0.001) / 0.33 mm (P<0.001) for interventricular septal wall thickness, and 0.32 mm (P<0.001) / 0.24 mm (P=0.004) for left ventricular posterior wall thickness, while the association sizes were non significant for the associations between indices of cardiac function and exercise systolic BP. After adjusted for gender, age, body mass index, coronary heart disease, and exercise BP, the association sizes with 1-SD increase in systolic BP at rest were 3.93 mm/s (P<0.001) for A peak and 0.46 (P=0.002) for E/e'. The association sizes with 1-SD increase in diastolic BP at rest were 2.91 mm/s (P=0.005) for A peak and -0.08 (P=0.002) for E/A, and 1-SD increase in systonic BP at rest were 0.26 mm for IVST (P=0.007), while there were no associations between indices of cardiac structure and systolic BP at rest with exception for interventricular septal wall thickness. After accounted for potential confounders, there was no association of left ventricular ejection fraction with BP during exercise and at rest.

Conclusion

Exercise BP was mainly associated with cardiac structure independent of BP at rest, while BP at rest was mainly correlated with cardiac diastolic function independently of exercise BP.

Key words: Blood pressure, Exercise, Echocardiography, Cardiac structure, Cardiac function

Abudukelimu Minawaer, Yuanyuan Zhou, Huiling Huang, Yugang Dong, Chen Liu, Fangfei Wei. The associations of cardiac structure and function with blood pressure at rest and during exercise[J]. Chinese Journal of Heart and Heart Rhythm(Electronic Edition), 2023, 11(03): 165-172.

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Figures/Tables 5

指标	总人群	男性	女性	P值
例数	323	130	193
年龄（岁， $x ¯ ± s$ ）	46.2±15.1	45.7±16.1	46.5±14.3	0.632
体重指数（kg/m²， $x ¯ ± s$ ）	23.5±3.4	24.1±3.2	23.0±3.4	0.008
高血压［例（%）］	83（25.7）	32（24.1）	51（26.8）	0.573
糖尿病［例（%）］	18（5.6）	10（7.5）	8（4.2）	0.202
冠心病［例（%）］	44（13.6）	27（20.8）	17（8.8）	0.002
静息血压（mmHg， $x ¯ ± s$ ）
收缩压	122.3±15.6	123.8±14.5	121.3±16.2	0.159
舒张压	77.6±10.5	77.5±9.9	77.7±10.9	0.892
运动血压（mmHg， $x ¯ ± s$ ）
收缩压	166.8±25.1	172.3±25.1	163.1±24.5	0.001
舒张压	80.3±13.7	80.9±14.6	79.8±13.1	0.484
心脏结构指标（mm， $x ¯ ± s$ ）
LAD	32.1±4.4	32.9±4.2	31.5±4.5	0.004
RVD	21.2±2.6	21.5±2.6	20.9±2.6	0.030
IVST	9.2±1.8	9.6±1.7	9.0±1.8	0.001
LVEDD	46.3±4.5	47.8±4.6	45.3±4.2	＜0.001
LVESD	27.8±3.5	28.8±3.7	27.2±3.2	＜0.001
LVPTW	8.2±1.5	8.6±1.4	7.9±1.4	＜0.001
舒张功能指标（ $x ¯ ± s$ ）
E峰（mm/s）	76.2±20.0	75.3±17.8	76.8±21.3	0.508
A峰（mm/s）	69.5±17.6	67.3±18.3	70.9±16.9	0.073
E/A	1.2±0.5	1.2±0.4	1.2±0.5	0.330
E/e’	7.9±2.4	7.9±2.7	8.0±2.2	0.825
PASP（mmHg）	26.5±4.6	26.4±3.7	26.6±5.2	0.783
收缩功能指标
LVEF（%）	70.1±5.6	69.8±5.8	70.3±5.5	0.471

指标	总人群	男性	女性	P值
例数	323	130	193
年龄（岁， $x ¯ ± s$ ）	46.2±15.1	45.7±16.1	46.5±14.3	0.632
体重指数（kg/m²， $x ¯ ± s$ ）	23.5±3.4	24.1±3.2	23.0±3.4	0.008
高血压［例（%）］	83（25.7）	32（24.1）	51（26.8）	0.573
糖尿病［例（%）］	18（5.6）	10（7.5）	8（4.2）	0.202
冠心病［例（%）］	44（13.6）	27（20.8）	17（8.8）	0.002
静息血压（mmHg， $x ¯ ± s$ ）
收缩压	122.3±15.6	123.8±14.5	121.3±16.2	0.159
舒张压	77.6±10.5	77.5±9.9	77.7±10.9	0.892
运动血压（mmHg， $x ¯ ± s$ ）
收缩压	166.8±25.1	172.3±25.1	163.1±24.5	0.001
舒张压	80.3±13.7	80.9±14.6	79.8±13.1	0.484
心脏结构指标（mm， $x ¯ ± s$ ）
LAD	32.1±4.4	32.9±4.2	31.5±4.5	0.004
RVD	21.2±2.6	21.5±2.6	20.9±2.6	0.030
IVST	9.2±1.8	9.6±1.7	9.0±1.8	0.001
LVEDD	46.3±4.5	47.8±4.6	45.3±4.2	＜0.001
LVESD	27.8±3.5	28.8±3.7	27.2±3.2	＜0.001
LVPTW	8.2±1.5	8.6±1.4	7.9±1.4	＜0.001
舒张功能指标（ $x ¯ ± s$ ）
E峰（mm/s）	76.2±20.0	75.3±17.8	76.8±21.3	0.508
A峰（mm/s）	69.5±17.6	67.3±18.3	70.9±16.9	0.073
E/A	1.2±0.5	1.2±0.4	1.2±0.5	0.330
E/e’	7.9±2.4	7.9±2.7	8.0±2.2	0.825
PASP（mmHg）	26.5±4.6	26.4±3.7	26.6±5.2	0.783
收缩功能指标
LVEF（%）	70.1±5.6	69.8±5.8	70.3±5.5	0.471

指标	静息收缩压		运动收缩压
指标	模型1 β（95%CI）	模型2 β（95%CI）	模型1 β（95%CI）	模型2 β（95%CI）
心脏结构
LAD（mm）	1.31（0.85~1.77）^a	0.53（0.10~0.96）^b	1.52（1.06~1.97）^a	0.98（0.57~1.40）^a
IVST（mm）	0.69（0.51~0.87）^a	0.41（0.23~0.58）^a	0.66（0.48~0.84）^a	0.44（0.27~0.61）^a
LVEDD（mm）	0.80（0.31~1.29）^a	0.46（-0.04~0.97）	1.15（0.67~1.63）^a	0.82（0.33~1.30）^a
LVESD（mm）	0.29（-0.09~0.67）	0.17（-0.22~0.57）	0.67（0.30~1.04）^a	0.55（0.16~0.93）^a
LVPWT（mm）	0.44（0.29~0.59）^a	0.23（0.08~0.38）^a	0.52（0.37~0.67）^a	0.35（0.21~0.50）^a
舒张功能
E峰（mm/s）	-1.96（-4.14~0.22）	0.47（-1.78~2.71）	-1.26（-3.45~0.93）	0.50（-1.69~2.69）
A峰（mm/s）	6.16（4.35~7.97）^a	4.31（2.48~6.14）^a	3.72（1.84~5.61）^a	2.51（0.69~4.34）^a
E/A	-0.13（-0.18~-0.09）^a	-0.06（-0.11~-0.02）^a	-0.11（-0.16~-0.06）^a	-0.06（-0.11~-0.02）^a
E/e’	0.67（0.42~0.93）^a	0.50（0.23~0.77）^a	0.42（0.16~0.68）^a	0.28（0.02~0.55）^b
收缩功能
LVEF（%）	0.17（-0.19~1.04）	0.18（-0.48~0.84）	0.07（-0.55~0.68）	-0.13（-0.77~0.52）

指标	静息舒张压		运动舒张压
指标	模型1 β（95%CI）	模型2 β（95%CI）	模型1 β（95%CI）	模型2 β（95%CI）
心脏结构
LAD（mm）	1.10（0.63~1.56）^a	0.66（0.25~1.07）^a	1.18（0.72~1.65）^a	0.67（0.25~1.08）^a
IVST（mm）	0.47（0.28~0.66）^a	0.31（0.14~0.48）a	0.61（0.42~0.79）^a	0.40（0.23~0.57）^a
LVEDD（mm）	0.76（0.27~1.25）^a	0.56（0.08~1.05）^b	0.49（-0.01~0.98）	0.28（-0.21~0.76）
LVESD（mm）	0.35（-0.03~0.73）	0.30（-0.08~0.68）	-0.02（-0.40~0.36）	-0.09（-0.47~0.30）
LVPWT（mm）	0.30（0.14~0.46）^a	0.18（0.04~0.33）^b	0.42（0.26~0.57）^a	0.27（0.13~0.42）^a
舒张功能
E峰（mm/s）	-4.06（-6.21~-1.92）^a	-3.04（-5.16~-0.92）^a	-3.41（-5.57~-1.25）^a	-1.81（-3.96~0.34）
A峰（mm/s）	4.48（2.61~6.34）^a	3.21（1.44~4.99）^a	3.72（1.84~5.61）^a	2.04（0.24~3.85）^b
E/A	-0.14（-0.19~-0.09）^a	-0.10（-0.14~-0.06）^a	-0.14（-0.19~-0.10）^a	-0.09（-0.13~-0.05）^a
E/e’	0.36（0.09~0.62）^a	0.25（-0.01~0.51）	0.51（0.25~0.77）^a	0.34（0.08~0.60）^a
收缩功能
LVEF（%）	0.19（-0.42~0.81）	0.01（-0.63~0.64）	0.68（0.07~1.29）^b	0.50（-0.14~1.13）

指标	收缩压		舒张压
指标	静息收缩压β（95%CI）	运动收缩压β（95%CI）	静息舒张压β（95%CI）	运动舒张压β（95%CI）
心脏结构
LAD（mm）	0.12（-0.35~0.59）	0.93（0.48~1.39）^a	0.44（-0.03~0.91）	0.45（-0.02~0.92）
IVST（mm）	0.26（0.07~0.46）^a	0.33（0.14~0.51）^a	0.15（-0.04~0.34）	0.33（0.13~0.52）^a
LVEDD（mm）	0.13（-0.43~0.68）	0.76（0.23~1.31）^a	0.56（0.01~1.11）^b	0.001（-0.55~0.55）
LVESD（mm）	-0.08（-0.52~0.36）	0.58（0.15~1.01）^a	0.45（0.01~0.88）^b	-0.31（-0.74~0.13）
LVPWT（mm）	0.09（-0.08~0.25）	0.32（0.16~0.48）^a	0.07（-0.10~0.23）	0.24（0.08~0.41）^a
舒张功能
E峰（mm/s）	0.30（-2.18~2.79）	0.38（-2.05~2.80）	-2.84（-5.26~-0.41）^b	-0.43（-2.87~2.01）
A峰（mm/s）	3.93（1.90~5.96）^a	0.86（-1.12~2.84）	2.91（0.88~4.94）^a	0.63（-1.41~2.67）
E/A	-0.04（-0.09~0.01）	-0.05（-0.09~0.002）	-0.08（-0.12~-0.03）^a	-0.05（-0.10~-0.004）^b
E/e’	0.46（0.17~0.76）^a	0.09（-0.20~0.38）	0.11（-0.18~0.41）	0.29（-0.01~0.58）
收缩功能
LVEF（%）	0.28（-0.45~1.02）	-0.25（-0.96~0.47）	-0.31（-1.03~0.42）	0.65（-0.08~1.37）

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