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Improvement in midwall myocardial shortening with regression of left ventricular hypertrophy

J Mayet1, B Ariff, B Wasan

  • 1Department of Cardiology, St. Mary's Hospital Praed Street, London W2 1NY, UK. j.mayet@ic.ac.uk

Hypertension (Dallas, Tex. : 1979)
|November 18, 2000
PubMed

Insights

Hypertensive patients with left ventricular hypertrophy (LVH) show reduced midwall systolic shortening. Antihypertensive therapy improved this midwall function, normalizing it after LVH regression.

Area of Science:

  • Cardiology
  • Hypertension Research
  • Echocardiography

Background:

  • Hypertension often leads to left ventricular hypertrophy (LVH).
  • LVH in hypertensive patients may present with impaired midwall systolic shortening despite normal overall left ventricular (LV) function.
  • The impact of antihypertensive therapy on midwall systolic function in LVH requires further investigation.

Purpose of the Study:

  • To confirm depressed midwall systolic shortening in hypertensive patients with LVH compared to normotensives.
  • To evaluate the effect of antihypertensive treatment causing LVH regression on LV systolic function, specifically midwall and endocardial shortening.

Main Methods:

  • Echocardiography was used to compare 38 hypertensive patients with LVH against 38 normotensive controls.
  • Midwall and endocardial fractional shortening were assessed.
  • 32 hypertensive patients with LVH received antihypertensive therapy (ramipril, felodipine, bendrofluazide) to achieve blood pressure <140/90 mm Hg.
  • Echocardiography was performed at baseline, after blood pressure control, and after 6 months of sustained control.

Main Results:

  • Hypertensive patients with LVH had significantly lower midwall shortening (17.9%) than controls (21.6%), while endocardial shortening and ejection fraction were similar.
  • Antihypertensive therapy successfully reduced blood pressure and LV mass index.
  • Midwall shortening significantly improved after LVH regression, reaching levels comparable to normotensive controls.

Conclusions:

  • Hypertensive patients with LVH exhibit reduced midwall systolic shortening, indicating subclinical myocardial dysfunction.
  • Effective blood pressure control and subsequent regression of LVH can normalize midwall systolic function.
  • Midwall shortening is a sensitive marker for assessing LV systolic function in hypertensive heart disease.

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