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Left ventricular midwall function improves with antihypertensive therapy and regression of left ventricular
A E Schussheim1, J A Diamond, R A Phillips
1Hypertension Section, The Zena and Michael A Wiener Cardiovascular Institute, The Mount Sinai Medical Center, New York, New York 10029, USA.
Insights
Antihypertensive therapy improves cardiac performance in patients with left ventricular hypertrophy (LVH). This therapy enhances midwall function, a key indicator of heart health, suggesting a role in managing hypertensive heart disease.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Left ventricular hypertrophy (LVH) regression with antihypertensive therapy may improve prognosis.
- The underlying mechanisms for this benefit are not fully understood.
- Midwall fractional shortening (mFS) is a sensitive marker of myocardial performance, often reduced in hypertensive patients with LVH.
Purpose of the Study:
- To investigate whether antihypertensive therapy can improve midwall function.
- To assess changes in cardiac performance using mFS and conventional echocardiographic parameters.
- To explore the relationship between antihypertensive therapy, LV mass regression, and cardiac function.
Main Methods:
- Serial echocardiographic measurements of mFS and other chamber function parameters.
- Study involved 29 hypertensive individuals over 6 months of drug therapy.
- Analysis included stress-adjusted and absolute midwall function.
Main Results:
- Significant improvements in both stress-adjusted (10%) and absolute (11%) midwall function were observed (p <0.05).
- No significant changes were noted in other conventional measures of chamber function.
- Improved function was more pronounced in patients with concentric remodeling and greater LV mass reduction.
Conclusions:
- Antihypertensive therapy is associated with improved cardiac performance, as measured by mFS.
- LV mass regression during antihypertensive treatment correlates with enhanced cardiac function.
- mFS may be valuable for identifying early hypertensive heart disease and monitoring therapeutic responses.
Abstract:
Recent evidence suggests that regression of left ventricular hypertrophy (LVH) with antihypertensive therapy improves prognosis. The mechanism for this benefit is unknown but may be related to effects on myocardial performance. Midwall fractional shortening (mFS) is often depressed in patients with asymptomatic hypertension, is associated with LVH, and is a potent, independent predictor of outcome. We therefore examined whether antihypertensive therapy may improve midwall performance. mFS as well as conventional echocardiographic parameters were measured serially among 29 hypertensive persons during 6 months of drug therapy. Stress-adjusted and absolute midwall function improved by 10% and 11%, respectively (p <0.05), whereas no significant changes were detected in other measures of chamber function. Improvement in function was more pronounced in patients with concentrically remodeled ventricular geometry and in those who achieved greater reductions in left ventricular (LV) mass. Antihypertensive therapy and LV mass regression is associated with demonstrable improvements in cardiac performance when assessed using mFS. Determinations of mFS may have a promising role in identifying patients with early hypertensive heart disease, tracking responses to therapy, and in elucidating the potential beneficial effects associated with LV mass regression.