Victor G. Dávila-Román, M.D., associate professor of medicine, has received a four-year $1.4 million grant from the National Heart, Lung and Blood Institute to study factors that lead to heart damage in people with thickened heart muscle due to high blood pressure.
High blood pressure and other conditions make the left ventricle, the main pumping chamber of the heart, work abnormally hard. This can cause muscle cells in the ventricle to plump up, producing a thick wall known as left ventricular hypertrophy (LVH). Although people with LVH can remain symptom-free for some time, the condition can set the stage for declining heart function and death.
Dávila-Román will investigate factors that could cause deteriorating heart function in people with high blood pressure and LVH and test whether heart medications reverse the damage. "Animal research suggests that drugs that only control high blood pressure may not adequately address abnormalities that develop with LVH," he said. "We hope to determine whether this is true in humans."
The study will involve participants between 20 and 80 years of age who will undergo echocardiographic evaluations of heart anatomy and function. Results in 44 volunteers with high blood pressure, LVH and normal heart function will be compared with those in eight normal volunteers and eight others who have high blood pressure, LVH and a moderate decline in function of the left ventricle.
Reduced blood flow to heart tissue could lead to declining heart function in people with hypertension and LVH. This might occur because coronary arteries at the heart surface might not carry enough blood through the thickened heart muscle, particularly under conditions of stress.
In collaboration with Robert J. Gropler, M.D., associate professor of radiology, Dávila-Román will use positron emission tomography (PET) images to evaluate heart blood flow in volunteers at rest and under a condition of stress.
The pumping action of volunteers' hearts also will be evaluated by Dávila-Román and Michael K. Pasque, M.D., professor of cardiothoracic surgery. They will obtain magnetic resonance images of heart contractile function in volunteers at rest and during administration of the testing drug dobutamine.
Dávila-Román suspects that the year-long evaluation will reveal that several factors underlie the increased cardiovascular risk of people with high blood pressure and LVH. "We hope to tease out which factor is most important and whether patients need more than one of these heart abnormalities to be at increased risk of developing heart failure," he said.
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