Highlights
- •Ejection fraction was similar between patients with secondary and essential hypertension.
- •Left ventricular mass index was higher in patients with secondary hypertension comparing with essential hypertension.
- •Left ventricular global longitudinal strain was lower in patients with secondary hypertension than in essential hypertensives.
Abstract
Aim
Information on systolic dysfunction, as assessed by left ventricular (LV) mechanics
in secondary hypertension is still largely limited. We performed a systematic meta-
analysis of 2D/3D speckle tracking studies in order to provide an updated comprehensive
information on this topic.
Methods
The PubMed, OVID-MEDLINE, and Cochrane library databases were analysed to search for
articles published from the inception up to March 31st 2021. Studies were identified
by using MeSH terms and crossing the following search items: “myocardial strain” “left
ventricular mechanics”, “speckle tracking echocardiography”, “systolic dysfunction”,
“hypertensive heart disease”, “left ventricular hypertrophy”, “secondary hypertension”,
“primary aldosteronism”, “pheochromocytoma”, “Cushing disease”, “renal artery stenosis”.
Results
On the whole, 515 patients with secondary hypertension (169 pheochromocytoma, 165
primary aldosteronism, 144 renal artery stenosis and 37 Cushing's syndrome) and 601
essential hypertensive patients from 11 studies were considered. Pooled ejection fraction
(EF) was similar in essential hypertensive controls and in patients with secondary
hypertension (SMD 0.12±0.06, CI: 0.001/0.25, p=0.05). Of note, EF was higher in patients
with pheochromocytoma than in essential hypertensives (0.50±0.11, CI: 0.27/0.73, p<0.001).
In contrast, pooled GLS was impaired in patients with secondary hypertension compared
to their essential hypertensive counterparts (SMD 0.83±0.26, CI: 0.32/1.30, p< 0.001).
Conclusions
The present meta-analysis adds a new piece of evidence by showing that GLS performs
better than EF in identifying systolic dysfunction in the setting of secondary hypertension.
In particular, this is true in patients with pheochromocytoma in whom conventional
EF suggests a normal or even super-normal systolic function.
Graphical abstract
Graphical Abstract
Keywords
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Article info
Publication history
Published online: October 26, 2021
Accepted:
October 15,
2021
Received in revised form:
October 12,
2021
Received:
July 1,
2021
Identification
Copyright
© 2021 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
