AIMS Hypertension is a well-established heart failure (HF) risk factor, especially in the context of adverse left ventricular (LV) remodelling. We aimed to use myocardial flow reserve (MFR) and global longitudinal strain (GLS), markers of subclinical microvascular and myocardial dysfunction, to refine hypertensive HF risk assessment. METHODS AND RESULTS Consecutive patients undergoing symptom-prompted stress cardiac positron emission tomography (PET)-computed tomography and transthoracic echocardiogram within 90 days without reduced left ventricular ejection fraction (<40%) or flow-limiting coronary artery disease (summed stress score ≥ 3) were included. Global MFR was quantified by PET, and echocardiograms were retrospectively analysed for cardiac structure and function. Patients were followed over a median 8.75 (Q1-3 4.56-10.04) years for HF hospitalization and a composite of death, HF hospitalization, MI, or stroke. Of 194 patients, 155 had adaptive LV remodelling while 39 had maladaptive remodelling, which was associated with lower MFR and impaired GLS. Across the remodelling spectrum, diastolic parameters, GLS, and N-terminal pro-B-type natriuretic peptide were independently associated with MFR. Maladaptive LV remodelling was associated with increased adjusted incidence of HF hospitalization and death. Importantly, the combination of abnormal MFR and GLS was associated with a higher rate of HF hospitalization compared to normal MFR and GLS [adjusted hazard ratio (HR) 3.21, 95% confidence interval (CI) 1.09-9.45, P = 0.034), including in the adaptive remodelling subset (adjusted HR 3.93, 95% CI 1.14-13.56, P = 0.030). CONCLUSION We have demonstrated important associations between coronary microvascular dysfunction and myocardial mechanics that refine disease characterization and HF risk assessment of patients with hypertension based on subclinical target organ injury.

中文翻译：

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高血压冠状动脉微血管功能障碍：终末器官损伤和心力衰竭的亚临床标志


目的 高血压是一种公认​​的心力衰竭 (HF) 危险因素，尤其是在不良左心室 (LV) 重构的情况下。我们的目的是利用心肌血流储备 (MFR) 和整体纵向应变 (GLS)（亚临床微血管和心肌功能障碍的标志物）来完善高血压心力衰竭风险评估。方法和结果 90 天内连续接受症状提示应激性心脏正电子发射断层扫描 (PET) 计算机断层扫描和经胸超声心动图的患者，无左心室射血分数降低（<40%）或血流限制性冠状动脉疾病（总应激评分≥3） ) 被包括在内。通过 PET 量化总体 MFR，并回顾性分析超声心动图的心脏结构和功能。患者因心衰住院以及死亡、心衰住院、心肌梗死或中风的综合情况接受中位随访 8.75 年（第 1-3 季度 4.56-10.04）年。在 194 名患者中，155 名患者存在适应性左室重塑，而 39 名患者存在适应不良性重塑，这与 MFR 较低和 GLS 受损有关。在整个重构谱中，舒张参数、GLS 和 N 末端 B 型利尿钠肽原与 MFR 独立相关。适应不良的左心室重构与调整后的心力衰竭住院和死亡发生率增加相关。重要的是，与正常 MFR 和 GLS 相比，异常 MFR 和 GLS 的组合与较高的心力衰竭住院率相关 [调整后的风险比 (HR) 3.21，95% 置信区间 (CI) 1.09-9.45，P = 0.034），包括在自适应重塑子集中（调整后的 HR 3.93，95% CI 1.14-13.56，P = 0.030）。 结论 我们已经证明了冠状动脉微血管功能障碍和心肌力学之间的重要关联，从而根据亚临床靶器官损伤完善了高血压患者的疾病特征和心力衰竭风险评估。