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Subclinical left ventricular dysfunction in systemic hypertension and the role of 24-hour blood pressure
G Schillaci1, P Verdecchia, G Reboldi
1Dipartimento di Cardiologia, Ospedale R. Silvestrini, Perugia, Italy. skill@unipg.it
Insights
Elevated 24-hour blood pressure (BP) is linked to reduced left ventricular (LV) systolic function in hypertension. Midwall fractional shortening (FS) better detects this depressed cardiac function than endocardial FS.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- The relationship between blood pressure (BP) and left ventricular (LV) systolic function in systemic hypertension remains debated.
- Assessing LV systolic function accurately is crucial for understanding hypertensive heart disease progression.
Purpose of the Study:
- To investigate the association between 24-hour BP and LV systolic function, specifically using midwall fractional shortening (FS).
- To determine if midwall FS is a more sensitive marker for detecting depressed cardiac function in never-treated hypertensive individuals compared to endocardial FS.
Main Methods:
- Echocardiography and 24-hour ambulatory BP monitoring were performed on 1,702 never-treated hypertensive subjects.
- LV midwall fractional shortening (FS) was calculated, accounting for epicardial migration during systole.
- Depressed LV function was defined as FS below the fifth percentile of predicted values based on healthy normotensives.
Main Results:
- Using midwall FS increased the detection of depressed LV function from 3.5% to 17.5% in hypertensive patients.
- Subjects with low midwall LV function exhibited similar office systolic BP but significantly higher 24-hour systolic BP compared to those with normal function.
- Midwall FS showed a stronger inverse correlation with 24-hour systolic BP and LV mass than endocardial FS.
Conclusions:
- Increased 24-hour BP load is associated with chronically depressed myocardial function in systemic hypertension, even without overt heart disease.
- Midwall FS is a more sensitive indicator of subclinical cardiac dysfunction in hypertensive individuals than endocardial FS.
- These findings highlight the importance of 24-hour BP monitoring for assessing cardiovascular risk in hypertension.
Abstract:
The relation between blood pressure (BP) and left ventricular (LV) systolic function in systemic hypertension is controversial. We assessed the relation of LV midwall fractional shortening (FS) to 24-hour BP in 1,702 never-treated hypertensive subjects (age 48 +/- 12 years), who underwent 24-hour BP monitoring and echocardiography. Stress-corrected endocardial and midwall FS (the latter calculated taking into account the epicardial migration of midwall during systole) were predicted in hypertensives on the basis of the values observed in 130 healthy normotensives (age 43 +/- 13 years, office BP 126/78 mm Hg). Subjects below the fifth percentile of observed-to-predicted FS had depressed LV function. The use of midwall FS resulted in an increase from 3.5% to 17.5% in the proportion of patients with depressed chamber function. Compared with the group with normal function, subjects with low midwall LV function had similar office systolic BP (155 +/- 21 vs 154 +/- 17 mm Hg), but increased 24-hour systolic BP (140 +/- 17 vs 133 +/- 12 mm Hg, p <0.001). Midwall FS had a closer negative relation to 24-hour systolic BP than to office systolic BP (r = -0.27 vs -0.08, p <0.001), whereas this difference was not apparent for diastolic BP (r = -0.23 vs -0.20). Compared with endocardial FS, midwall FS had a stronger inverse association to LV mass (r = -0.45 vs -0.16, p <0.001). Thus, an increased 24-hour BP load may chronically lead to depressed myocardial function in systemic hypertension in the absence of clinically overt heart disease.