The possibility that long-term isometric handgrip exercise contributes to left atrial enlargement in patients with hypertension.
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ABSTRACT:
SUBMITTER: Kemi Y
PROVIDER: S-EPMC8029911 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Aerobic exercise reduces blood pressure (BP) on average 5-7?mmHg among those with hypertension; limited evidence suggests similar or even greater BP benefits may result from isometric handgrip (IHG) resistance exercise.We conducted a randomized controlled trial investigating the antihypertensive effects of an acute bout of aerobic compared with IHG exercise in the same individuals. Middle-aged adults (n?=?27) with prehypertension and obesity randomly completed three experiments: aerobic (60% peak oxygen uptake, 30 min); IHG (30% maximum voluntary contraction, 4?×?2 min bilateral); and nonexercise control. Study participants were assessed for carotid-femoral pulse wave velocity pre and post exercise, and left the laboratory wearing an ambulatory BP monitor.SBP and DBP were lower after aerobic versus IHG (4.8?±?1.8/3.1?±?1.3?mmHg, P?=?0.01/0.04) and control (5.6?±?1.8/3.6?±?1.3?mmHg, P?=?0.02/0.04) over the awake hours, with no difference between IHG versus control (P?=?0.80/0.83). Pulse wave velocity changes following acute exercise did not differ by modality (aerobic increased 0.01?±?0.21?ms, IHG decreased 0.06?±?0.15?ms, control increased 0.25?±?0.17?ms, P?>?0.05). A subset of participants then completed either 8 weeks of aerobic or IHG training. Awake SBP was lower after versus before aerobic training (7.6?±?3.1?mmHg, P?=?0.02), whereas sleep DBP was higher after IHG training (7.7?±?2.3?mmHg, P?=?0.02).Our findings did not support IHG as antihypertensive therapy but that aerobic exercise should continue to be recommended as the primary exercise modality for its immediate and sustained BP benefits.
| S-EPMC5713890 | biostudies-literature
Project description:BackgroundCycle exercise echocardiography is a useful tool to "unmask" diastolic dysfunction; however, this approach can be limited by respiratory and movement artifacts. Isometric handgrip avoids these issues while reproducibly increasing afterload and myocardial oxygen demand.HypothesisIsometric handgrip echocardiography (IHE) can differentiate normal from abnormal diastolic function.MethodsFirst recruited 19 young healthy individuals (mean age, 24 ± 4 years) to establish the "normal" response. To extend these observations to a more at-risk population, we performed IHE on 17 elderly individuals (mean age, 72 ± 6 years) with age-related diastolic dysfunction. The change in the ratio of mitral valve inflow velocity to lateral wall tissue velocity (E/e'), a surrogate for left ventricular filling pressure, was used to assess the diastolic stress response in each group.ResultsIn the young subjects, isometric handgrip increased heart rate and mean arterial pressure (25 ± 12 bpm and 26 ± 17 mmHg, respectively), whereas E/e' changed minimally (0.6 ± 0.9). In the elderly subjects, heart rate and mean arterial pressure were similarly increased with isometric handgrip (19 ± 16 bpm and 25 ± 11 mmHg, respectively), whereas E/e' increased more dramatically (2.3 ± 1.7). Remarkably, 11 of the 17 elderly subjects had an abnormal diastolic response (ΔE/e': 3.4 ± 1.1), whereas the remaining 6 elderly subjects showed very little change (ΔE/e': 0.3 ± 0.7), independent of age or the change in myocardial oxygen demand.ConclusionsIHE is a simple, effective tool for evaluating diastolic function during simulated activities of daily living.
| S-EPMC6490388 | biostudies-literature
Project description:We sought to evaluate the clinical implication of LAE based on left atrial anterior-posterior (LA AP) dimension or LA volume index (LAVI) in Korean patients with atrial fibrillation (AF). We enrolled 8159 AF patients from the CODE-AF registry. The primary outcome was rate of stroke or systemic embolism (SSE). The prevalence of mild, moderate, and severe LAE by LA AP dimension was 30.6%, 18.5%, and 21.4%, and by LAVI (available in 5808 patients) was 15.7%, 12.5% and 37.8%, respectively. Compared with no or mild LAE, patients with significant LAE (moderate to severe LAE, n = 3258, 39.9%) were associated with a higher rate of SSE (2.5% vs. 1.4%, P = 0.001). Multivariable analysis suggested presence of significant LAE by LA AP dimension was associated with a higher risk of SSE in the overall population (HR 1.57, 95% CI: 1.14-2.17, P = 0.005) and in patients using anticoagulants (n = 5836, HR 1.79, 95% CI: 1.23-2.63, P = 0.002). Patients with significant LAE by LAVI were also at higher risk of SSE (HR 1.58, 95% CI: 1.09-2.29, P = 0.017). In conclusion, significant LAE by LA dimension or LAVI was present in 39.9% and 50.2% of AF patients, respectively, and was associated with a higher rate of SSE.
| S-EPMC8664956 | biostudies-literature
Project description:Hypertension is a major risk factor contributing to cardiovascular disease, which is the number one cause of deaths worldwide. Although antihypertensive medications are effective at controlling blood pressure, current first-line treatment for hypertension is nonpharmacological lifestyle modifications. Recent studies indicate that isometric resistance training (IRT) may also be effective for assisting with blood pressure management. The aim of this study was to determine the efficacy of IRT for blood pressure management and the suitability of a low-intensity working control group.Forty hypertensive individuals, aged between 36 and 65 years, conducted IRT for 8 weeks. Participants were randomized into 2 groups, working at an intensity of either 5% or 30% of their maximum voluntary contraction. Participants performed 4?×?2?minute isometric handgrip exercises with their nondominant hand, each separated by a 3-minute rest period, 3 days a week.Blood pressure measurements were conducted at baseline and at the end of the protocol using a Finometer. Eight weeks of isometric resistance training resulted in a 7-mmHg reduction of resting systolic blood pressure (SBP) (136?±?12 to 129?±?15; P?=?0.04) in the 30% group. Reductions of 4?mmHg were also seen in mean arterial pressure (MAP) (100?±?8 to 96?±?11; P?=?0.04) in the 30% group. There were no statistically significant reductions in diastolic blood pressure for the 30% group, or any of the data for the 5% group.Isometric resistance training conducted using handgrip exercise at 30% of maximum voluntary contraction significantly reduced SBP and MAP. A lack of reduction in blood pressure in the 5% group indicates that a low-intensity group may be suitable as a working control for future studies.
| S-EPMC5207598 | biostudies-literature
Project description:Background and purposeAlthough left atrial enlargement (LAE) increases incident stroke risk, the association with recurrent stroke is less clear. Our aim was to determine the association of LAE with recurrent stroke most likely related to embolism (cryptogenic and cardioembolic) and all ischemic stroke recurrences.MethodsWe followed 655 first ischemic stroke patients in the Northern Manhattan Stroke Study for ≤5 years. LA size from 2D echocardiography was categorized as normal LAE (52.7%), mild LAE (31.6%), and moderate-severe LAE (15.7%). We used Cox proportional hazard models to calculate the hazard ratios and 95% confidence intervals for the association of LA size and LAE with recurrent cryptogenic/cardioembolic and total recurrent ischemic stroke.ResultsLA size was available in 529 (81%) patients. Mean age at enrollment was 69±13 years; 45.8% were male, 54.0% Hispanic, and 18.5% had atrial fibrillation. Over a median of 4 years, there were 65 recurrent ischemic strokes (29 were cardioembolic or cryptogenic). In multivariable models adjusted for confounders, including atrial fibrillation and heart failure, moderate-severe LAE compared with normal LA size was associated with greater risk of recurrent cardioembolic/cryptogenic stroke (adjusted hazard ratio 2.83, 95% confidence interval 1.03-7.81), but not total ischemic stroke (adjusted hazard ratio 1.06, 95% confidence interval, 0.48-2.30). Mild LAE was not associated with recurrent stroke.ConclusionModerate to severe LAE was an independent marker of recurrent cardioembolic or cryptogenic stroke in a multiethnic cohort of ischemic stroke patients. Further research is needed to determine whether anticoagulant use may reduce risk of recurrence in ischemic stroke patients with moderate to severe LAE.
| S-EPMC4442058 | biostudies-literature
Project description:ContextHigh blood pressure is one of the leading preventable causes of cardiovascular death worldwide. In this regard, several studies have shown interest in the benefits of isometric exercise on blood pressure regulation.ObjectiveTo assess whether low-intensity isometric handgrip exercise (LI-IHE) is an effective strategy to lower blood pressure levels in prehypertensive and hypertensive patients.Data sourceThis study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement and registered with PROSPERO. Potentially eligible studies were identified after a systematic search conducted on 4 international databases: PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), PEDro, and SPORTDiscus.Study selectionWe included randomized controlled trials that comprised patients who received LI-IHE.Study designSystematic review with meta-analysis.Level of evidenceLevel 3.Data extractionData related to patient characteristics, exercise programs, risk-of-bias assessment, and outcomes of interest were systematically reviewed independently by 2 authors.ResultsThe following reductions (mean differences) were observed after LI-IHE: systolic blood pressure (SBP), (MD) = -5.43 mm Hg; (95% CI, -8.47 to -2.39; P = 0.0005); diastolic blood pressure (DBP), -2.41 mm Hg (95% CI, -4.33 to -0.48; P = 0.01); mean arterial pressure (MAP), -1.28 mm Hg (95% CI, -2.99 to 0.44; P = 0.14).ConclusionLI-IHE seems to lower SBP, DBP, and MAP values in prehypertensive and hypertensive adults. It appears that LI-IHE reduces, in greater magnitude, blood pressure levels in hypertensive patients, specifically in patients aged <45 years, those who are overweight, and those on medications. Nevertheless, substantial heterogeneity in the main results and in the analyses by subgroups generated uncertainty about the real reduction magnitude that LI-IHE can produce on blood pressure.
| S-EPMC7485025 | biostudies-literature
Project description:Background Despite correction of the atrial septal defect (ASD), patients experience atrial fibrillation frequently and have increased morbidity and mortality. We examined physical capacity, cardiac performance, and invasive hemodynamics in patients with corrected ASD. Methods and Results Thirty-eight corrected patients with isolated secundum ASD and 19 age-matched healthy controls underwent right heart catheterization at rest and during exercise with simultaneous expired gas assessment and echocardiography. Maximum oxygen uptake was comparable between groups (ASD 32.7±7.7 mL O2/kg per minute, controls 35.2±7.5 mL O2/kg per minute, P=0.3), as was cardiac index at both rest and peak exercise. In contrast, pulmonary artery wedge v wave pressures were increased at rest and peak exercise (rest: ASD 14±4 mm Hg, controls 10±5 mm Hg, P=0.01; peak: ASD 25±9 mm Hg, controls 14±9 mm Hg, P=0.0001). The right atrial v wave pressures were increased at rest but not at peak exercise. The transmural filling pressure gradient (TMFP) was higher at peak exercise among patients with ASD (10±6 mm Hg, controls 7±3 mm Hg, P=0.03). One third of patients with ASD demonstrated an abnormal hemodynamic exercise response defined as mean pulmonary artery wedge pressure ≥25 mm Hg and/or mean pulmonary artery pressure ≥35 mm Hg at peak exercise. These patients had significantly elevated peak right and left atrial a wave pressures, right atrial v wave pressures, pulmonary artery wedge v wave pressures, and transmural filling pressure compared with both controls and patients with ASD with a normal exercise response. Conclusions Patients with corrected ASD present with elevated right and in particular left atrial pressures at rest and during exercise despite preserved peak exercise capacity. Abnormal atrial compliance and systolic atrial function could predispose to the increased long-term risk of atrial fibrillation. Registration Information clinicaltrials.gov. Identifier: NCT03565471.
| S-EPMC8483478 | biostudies-literature
Project description:Vascular dysfunction may occur prior to declines in cognitive function and accumulation of neuropathology. White matter hyperintensities (WMH) develop due to cerebral ischemia and elevated blood pressure in midlife. The purpose of this study was to evaluate associations between cardiovascular and cerebrovascular responses to sympathoexcitatory stimuli and WMH burden in cognitively unimpaired middle-aged and older adults. Sixty-eight adults (age = 63 ± 4y, men = 20, women = 48) participated in this study. Participants completed isometric handgrip exercise (IHG) exercise at 40% of maximal voluntary contraction until fatigue followed by a 90s period of post-exercise ischemia. Heart rate (HR), mean arterial pressure (MAP), middle cerebral artery blood velocity (MCAv), and end-tidal CO2 were continuously measured throughout the protocol. Cerebrovascular resistance index (CVRi) was calculated as MAP/MCAv. WMH lesion volume and intracranial volume (ICV) were measured using a FLAIR and T1 scan on a 3T MRI scanner, respectively. WMH fraction was calculated as (WMH lesion volume/ICV)*100 and cubic root transformed. Multiple linear regressions were used to determine the association between cardiovascular and cerebrovascular responses to IHG exercise and post-exercise ischemia and WMH fraction. Multiple linear regression models were adjusted for age, sex, apolipoprotein ε4 status, and total work performed during IHG exercise. During IHG exercise, there were significant increases from baseline in HR (25 ± 12%), MAP (27 ± 11%), MCAv (5 ± 10%), and CVRi (22 ± 17%; P < 0.001 for all). During post-exercise ischemia, HR (8 ± 7%), MAP (22 ± 9%), and CVRi (23 ± 16%) remained elevated (P < 0.001) while MCAv (0 ± 10%) was not different compared to baseline. There was an inverse association between the percent change in HR (r = -0.42, P = 0.002), MAP (r = -0.41, P = 0.002), and CVRi (r = -0.31, P = 0.045), but not MCAv (r = 0.19, P = 0.971) in response to IHG exercise and WMH fraction. There were no associations between responses to post-exercise ischemia and WMH fraction. Lower sympathoexcitatory responses to IHG exercise are associated with greater WMH burden in middle-aged to older adults. These findings suggest that individuals who demonstrate smaller increases in HR, MAP, and CVRi in response to sympathoexcitatory stress have greater WMH burden.
| S-EPMC9309556 | biostudies-literature
Project description:Genome-wide association studies have reported a strong association of the single nucleotide polymorphism (SNP) rs6817105 (T?>?C) on chromosome 4q25 with atrial fibrillation (AF), but phenotype alterations conferred by this SNP have not been described. We genotyped SNP rs6817105 and examined the relationships among rs6817105 genotype, clinical characteristics, echocardiographic parameters, and electrophysiological parameters in 574 AF patients and 1,554 non-AF controls. Further, multiple microRNAs (miRNAs) are reported to be involved in atrial remodeling and AF pathogenesis, so we investigated relationships between rs6817105 genotype and serum concentrations of 2555 miRNAs. The rs6817105 minor allele frequency was significantly higher in AF patients than non-AF controls (66% vs. 47%, odds ratio 2.12, p?=?4.9?×?10-26). Corrected sinus node recovery time (CSRT) was longer and left atrial volume index (LAVI) was larger in AF patients with the rs6817105 minor allele than patient non-carriers (CSRT: CC 557?±?315?ms, CT 486?±?273?ms, TT 447?±?234?ms, p?=?0.001; LAVI: CC 43.6?±?12.1, CT 42.4?±?13.6, TT 39.8?±?11.6, p?=?0.030). There were no significant differences between rs6817105 genotype and the serum concentrations of miRNAs. These findings strongly implicate rs6817105 minor allele in sinus node dysfunction and left atrial enlargement.
| S-EPMC6167315 | biostudies-literature
Project description:Background: Left atrial enlargement (LAE) can independently predict the development of a variety of cardiovascular diseases. Objectives: This study sought to develop an artificial intelligence approach for the detection of LAE based on 12-lead electrocardiography (ECG). Methods: The study population came from an epidemiological survey of heart disease in Guangzhou. Elderly people (3,391) over 65 years old who had both 10-s 12 lead ECG and echocardiography were enrolled in this study. The left atrial (LA) anteroposterior diameter >40 mm on echocardiography was diagnosed as LAE, and the LA anteroposterior diameter was indexed by body surface area (BSA) to classify LAE into different degrees. A convolutional neural network (CNN) was trained and validated to detect LAE from normal ECGs. The performance of the model was evaluated by calculating the area under the curve (AUC), accuracy, sensitivity, specificity, and F1 score. Results: In this study, gender, obesity, hypertension, and valvular heart disease seemed to be related to left atrial enlargement. The AI-enabled ECG identified LAE with an AUC of 0.949 (95% CI: 0.911-0.987). The sensitivity, specificity, accuracy, precision, and F1 score were 84.0%, 92.0%, 88.0%, 91.3%, and 0.875, respectively. Physicians identified LAE with sensitivity, specificity, accuracy, precision, and F1 scores of 38.0%, 84.0%, 61.0%, 70.4%, and 0.494, respectively. In classifying LAE in different degrees, the AUCs of identifying normal, mild LAE, and moderate-severe LAE ECGs were 0.942 (95% CI: 0.903-0.981), 0.951 (95% CI: 0.917-0.987), and 0.998 (95% CI: 0.996-1.00), respectively. The sensitivity, specificity, accuracy, positive predictive value, and F1 scores of diagnosing mild LAE were 82.0%, 92.0%, 88.7%, 89.1%, and 0.854, while the sensitivity, specificity, accuracy, positive predictive value, and F1 scores of diagnosing moderate-severe LAE were 98.0%, 84.0%, 88.7%, 96.1%, and 0.969, respectively. Conclusions: An AI-enabled ECG acquired during sinus rhythm permits identification of individuals with a high likelihood of LAE. This model requires further refinement and external validation, but it may hold promise for LAE screening.
| S-EPMC7773668 | biostudies-literature