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Changes in midwall systolic performance and cardiac hypertrophy reduction in hypertensive patients
M L Muiesan1, M Salvetti, C Monteduro
1Department of Medical and Surgical Sciences, Internal Medicine, University of Brescia, Italy. muiesan@master.cci.unibs.it
Insights
Reducing cardiac hypertrophy through antihypertensive therapy significantly improves left ventricular (LV) midwall systolic performance. This improvement in LV function was observed even with persistent high blood pressure, highlighting the benefits of LVH reduction.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Hypertension Research
Background:
- Left ventricular hypertrophy (LVH) is associated with impaired cardiac function.
- Antihypertensive therapy aims to reduce LV mass and improve cardiovascular outcomes.
- Understanding the impact of LVH reduction on systolic performance is crucial for patient management.
Purpose of the Study:
- To evaluate changes in left ventricular (LV) midwall fractional shortening (FS) after reducing cardiac hypertrophy.
- To assess the relationship between LV mass reduction and systolic performance in hypertensive patients.
Main Methods:
- M-mode echocardiography was used to assess LV anatomy and function in 68 hypertensive patients.
- Patients were stratified based on baseline LV hypertrophy (LVH) and changes in LV mass index (LVMI) after treatment.
- Midwall LV fractional shortening (FS) was measured at baseline, during treatment, and after treatment withdrawal.
Main Results:
- Patients with reduced LVH showed significantly increased midwall FS during and after treatment.
- Persistently elevated LV mass was associated with lower midwall FS.
- Changes in midwall FS were independently associated with modifications in relative wall thickness, end-diastolic dimensions, and LVMI.
Conclusions:
- Reduction of LVH significantly improves LV midwall systolic performance, irrespective of blood pressure levels.
- Modifications in relative wall thickness are strongly linked to improvements in midwall systolic function and LV dimensions.
Objective:
To investigate changes in left ventricular (LV) performance, as evaluated by measurement of midwall LV fractional shortening (FS), after reduction of cardiac hypertrophy.
Design And Methods:
Echocardiographic evaluation of LV anatomy and function was performed by M-mode echocardiography at baseline, after long-term antihypertensive therapy, and after treatment withdrawal in 68 asymptomatic hypertensive patients (50 males, 18 females, age range 22-62 years). Patients were divided according to the presence of LV hypertrophy (LVH) at baseline (LV mass index, LVMI, > or = 51 g/m(2.7)).
Results:
At baseline patients with concentric (relative wall thickness > 0.44) LV hypertrophy (n = 38) or remodelling (n = 7) had reduced midwall shortening with respect to patients with normal LV geometry (n = 4) or eccentric LVH (n = 19); no differences were observed for endocardial FS. After long-term treatment (average 15 months), in 11 patients LV mass remained within normal limits, in 45 patients LVH reduction was obtained, while in 12 patients LV mass remained persistently elevated. Midwall FS was significantly increased in patients with reduction of LVH both during treatment and after withdrawal of treatment, while it remained significantly lower in patients with persistently elevated LV mass. Changes in midwall fractional shortening were independently associated with modifications in relative wall thickness (P < 0.00001), with changes in end-diastolic dimensions (P < 0.0001) and those of LVMI (P< 0.02) as shown by multivariate analysis.
Conclusion:
LV midwall systolic performance significantly improved after reduction of LVH, even in the presence of high blood pressure values. Modifications in relative wall thickness are more independently associated with changes, in LV diastolic dimensions and mass, to midwall improvement