Table 7.
| Study | N. | Gender (F/M) | BMI (kg/m2) |
Age (y) |
CVRF | EF (%) |
MEE (mL/s) |
MEEi (mL/s/g) |
Remarks |
|---|---|---|---|---|---|---|---|---|---|
| De Simone G. et al. Journal of Hypertension 2009 [2] | 255 | 151/105 | 27.1 ± 6.6 | 35.3 ± 11.9 | Healthy subjects—no CVRF | 64.6 ± 4.9 | 86.1 ± 25.7 | - | Volunteers involved in a screening program of the department staff or subjects referred to the “Outpatient Nutrition Clinic”. |
| 56 | 26/29 | 27.9 ± 4.8 | 49.3 ± 9.5 | Hypertension | 63.1 ± 6.09 | Low MEE | - | Subjects were divided in groups with normal and low myocardial mechanical efficiency (i.e., below the 90th percentile of the normal distribution; normal distribution: 85.4 ± 22.6) .After adjusting for age and sex, hypertensive patients with low MEE showed greater relative wall thickness and lower EF and midwall shortening than patients with normal MEE. Low MEE was also associated with inappropriately high LV mass. |
|
| 250 | 103/148 | 27.9 ± 4.3 | 47.1 ± 10.6 | Hypertension | 66.5 ± 5.4 | Normal MEE | - | ||
| De Simone G. et al. Journal of Hypertension 2016 [3] | 12353 | 5429/7008 | - | 52.4 ± 12.5 | Hypertension (100%), obesity (26%), diabetes (10%) * | 66.3 ± 3.9 | 62.6 ± 14.4 | F:0.35 ± 0.08 M:0.33 ± 0.07 | Patients selected from the Campania Salute Network (CSN) Registry. Low MEE was associated with altered metabolic profile, LVH, concentric left ventricular geometry, and diastolic dysfunction and predicted CV end-points, independently of age, sex, LVH antihypertensive therapy, and CVRF. |
| Mancusi C. et al. Journal of Clinical Medicine 2021 [4] |
111 | F 42% | 33 ± 5 | 48 ± 9 | Hypertension (85%), obesity (75%), diabetes (10%) ** | 61 ± 6 | - | ≤0.41 | Subjects participating in the fat-associated cardiovascular dysfunction (FATCOR) study. Reduced MEEi was associated with lower LV myocardial function both in the circumferential and in the longitudinal direction, independent of cardiometabolic factors. |
| 120 | F 58% | 32 ± 4 | 49 ± 9 | Hypertension (76%), obesity (62%), diabetes (9%) ** | 62 ± 7 | - | 0.42–0.54 | ||
| 125 | F 68% | 32 ± 4 | 46 ± 9 | Hypertension (71%), obesity (67%), diabetes (4%) ** | 64 ± 6 | - | 0.54–0.67 | ||
| 124 | F 75% | 31 ± 4 | 47 ± 9 | Hypertension (65%), obesity (48%), diabetes (7.5%) ** | 63 ± 6 | - | ≥0.67 | ||
| Losi MA. et al. Journal of Clinical Medicine 2019 [5] |
478 | F 55% | 60 ± 8 | Hypertension (34%), obesity (58%), diabetes (57%), hyperlipemia (62%), former smoker (38%), current smoker (35%) * | - | - | ≤0.34 | Data from the “Strong Heart Study” (SHS), a population-based cohort with CVRF but free of CV disease. A low LV MEEi was a predictor of incident, non-AMI related HF in subjects with initially normal EF. |
|
| 479 | F 65% | 59 ± 8 | Hypertension (29%), obesity (57%), diabetes (41%), hyperlipemia (59%), former smoker (36%), current smoker (34%) * | - | - | 0.35–0.39 | |||
| 477 | F 69% | 60 ± 8 | Hypertension (25%), obesity (51%), diabetes (37%), hyperlipemia (55%), former smoker (34%), current smoker (35%) * | - | - | 0.40–0.44 | |||
| 478 | F 68% | 59 ± 8 | Hypertension (22%), obesity (40%), diabetes (25%), hyperlipemia (57%), former smoker (33%), current smoker (39%) * | - | - | ≥0.45 | |||
| Manzi MV. et al. ESC Heart Fail. 2022 [6] |
5536 | F 42.1% | 53.40 ± 11.41 | Hypertension (100%), obesity (24.3%), diabetes (9.8%), smoker (19.1%) * | 65.8 ± 3.86 | - | 0.34 ± 0.07 | Patients selected from the Campania Salute Network (CSN) Registry. Lower values of MEEi at baseline significantly contributed to identify patients more prone to develop LV systolic dysfunction. |
|
| 137 | F 38% | 59.46 ± 11.58 | Hypertension (100%), obesity (27%), diabetes (18.2%), smoker (19%) * | 65.2 ± 11.5 | - | 0.32 ± 0.08 | |||
| Bahlmann E. et al. Open Heart 2021 [18] |
569 | F 35% | 27.9 ± 4.7 | 68 ± 10 | Hypertension (88%), obesity (28%) *** | 65 ± 7 | - | <0.34–0.26 ± 0.06 | Post hoc analysis performed within the prospective Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) study. In patients with initially asymptomatic aortic stenosis, a low MEEi was associated with clustering of cardiometabolic risk factors, lower LV myocardial function and subsequent increased mortality during a 4.3 year follow-up, independent of known prognosticators. |
| 1134 | F 41% | 26.3 ± 4.1 | 67 ± 10 | Hypertension (81%), obesity (16%) *** | 67 ± 6 | - | ≥0.34–0.54 ± 0.16 | ||
| Fiorentino TV et al. Diabetes Research and Clinical Practice 2021 [7] |
617 NGT 1 h-low (1) | 389/228 | 29.4 ± 6.6 | 44 ± 13 | ≥1 cardio-metabolic risk factors **** | - | - | 0.41 ± 0.11 | The study cohort consisted of 1467 non-diabetic adult subjects participating in the CATAMERI study. Subjects with NGT 1 h-high, isolated IFG, and IGT had a raised myocardial oxygen consumption and a reduced MEE. |
| 210 NGT 1 h-high (2) | 100/110 | 30.1 ± 5.9 | 49 ± 12 | ≥1 cardio-metabolic risk factors **** | - | - | 0.38 ± 0.11 | ||
| 237 Isolated IFG (3) | 94/143 | 30.3 ± 5.3 | 54 ± 11 | ≥1 cardio-metabolic risk factors **** | - | - | 0.37 ± 0.10 | ||
| 403 IGT (4) | 217/186 | 31.4 ± 5.9 | 54 ± 12 | ≥1 cardio-metabolic risk factors **** | - | - | 0.35 ± 0.09 | ||
| Cioffi G. et al. Journal of Hypertension 2021 [8] |
432 | F 64% | 26.0 ± 4.5 | 57 ± 12 | Hypertension (46%), obesity (16%), diabetes (9%), hyperlipemia (56%), active smoker (34%) | 66 ±7 | - | 0.35 ± 0.11 | The study population consisted of 432 outpatients with established chronic inflammatory arthritis without overt cardiac disease, compared to 216 patients without chronic inflammatory arthritis. In patients with chronic inflammatory arthritis, a low-MEE was a powerful prognosticator of adverse CV events. |
| 216 | F 58% | 25.4 ± 4.3 | 59 ± 14 | Hypertension (46%), obesity (16%), diabetes (9%), hyperlipemia (56%), active smoker (34%) | 64 ± 9 | - | 0.45 ± 0.10 |
The table collects the values of MEE and MEEi provided by previous studies. Most studies included subjects with different cardio-metabolic risk factors, except for one study of 255 healthy subjects [3]. BMI, body mass index; CV, cardiovascular; CVRF, cardiovascular risk factors; EF, ejection fraction; IFG, impaired glucose tolerance; MEE, myocardial mechanical efficiency; MEEi, indexed myocardial mechanical efficiency; NGT, normal glucose tolerance. * Arterial hypertension was defined as office BP values at least 140 (SBP) and/or at least 90 mmHg (DBP) or when participants were taking antihypertensive medications. Obesity was defined as a BMI of at least 30 kg/m2. Diabetes was defined as fasting plasma glucose >125 mg/dL or current antidiabetic treatment. ** Hypertension was considered present if the 24 h ambulatory BP was elevated or if the participants reported the use of antihypertensive medications. Obesity was defined as BMI ≥30.0 kg/m2. Diabetes mellitus was considered present if fasting blood glucose ≥7 mmol/L, 2 h blood glucose ≥11.1 mmol/L after a 75 g oral glucose test, or glycated hemoglobin A1c ≥6.5%. *** Obesity was defined as body mass index ≥30 kg/m2. Hypertension was defined as history of hypertension or current antihypertensive treatment or elevated blood pressure at the baseline clinical visit. **** Cardio-metabolic risk factors included family history of diabetes, dysglycemia, hypertension, dyslipidemia, and overweight/obesity. Individuals were classified as having normal glucose tolerance (NGT) when fasting plasma glucose was < 100 mg/dL and 2 h post-load glucose was <140 mg/dL; isolated impaired fasting glucose (IFG) when fasting plasma glucose was 100–125 mg/dL and 2 h post-load glucose was <140; impaired glucose tolerance (IGT) when 2 h post-load glucose was 140–199 mg/dL in accordance with the ADA criteria. Individuals with NGT were further subdivided into two groups (NGT 1 h-low and NGT 1 h-high) using the 1 h plasma glucose cut-off of 155 mg/dL.