The influence of resting, exercise-induced hypertension and cardiac remodeling on myocardial work indices

Abstract Background Hypertension is a leading risk factor for cardiovascular disease and can subtly affect myocardial function before clinical manifestation. Advanced myocardial mechanics, such as Myocardial Work (MW) indices—Global Work Efficiency (GWE), Global Work Index (GWI), Global Constructive Work (GCW), and Global Wasted Work (GWW)—offer sensitive measures of cardiac performance. The impact of hypertension left ventricular (LV) remodelling and hypertensive responses to exercise on these parameters remains underexplored. Aims This study aimed to: 1. Compare MW parameters between hypertensive and normotensive individuals; 2. Investigate the impact of elevated resting blood pressure (BP) and hypertensive response during exercise on myocardial function; 3. Assess the influence of left ventricular remodeling on MW indices. Methods We conducted a single-center study of 822 patients without known cardiovascular disease who underwent exercise echocardiography. Of these, 583 patients completed the test (achieving predicted METs >85%). Participants were stratified by hypertension status, baseline BP, exercise-induced hypertensive response and LV echocardiographic remodeling patterns, including concentric remodeling and concentric left ventricle hypertrophy (LVH). Results Hypertension did not limit test completion. Hypertensive patients had higher E/e′ and significantly lower GWI compared to normotensive individuals. Left ventricular remodeling patterns, except for concentric hypertrophy, did not significantly affect MW indices. Concentric hypertrophy was associated with higher GWW (p=0.022). The most significant determinants of MW parameters were elevated baseline (BP) and hypertensive responses during exercise (p