Midwall mechanics are improved after regression of hypertensive left ventricular hypertrophy and normalization of...

Area of Science:

• Cardiology
• Cardiovascular Physiology
• Echocardiography

Background:

• Hypertensive left ventricular hypertrophy (LVH) is common, but its impact on left ventricular (LV) myocardial function after regression is not fully understood.
• The relationship between LVH regression, normalization of cardiac geometry, and myocardial function requires further investigation.

Purpose of the Study:

• To investigate whether substantial regression of hypertensive LVH and normalization of LV geometry are linked to improved LV myocardial function.
• To determine the relative contributions of reduced LV systolic stress and normalized LV geometry to improved midwall function.

Main Methods:

• 152 patients with hypertensive LVH underwent 1 year of antihypertensive treatment (lisinopril +/- hydrochlorothiazide).
• Echocardiography assessed LV mass, relative wall thickness, and midwall fractional shortening before, during, and after treatment.
• 24-hour ambulatory blood pressure monitoring evaluated blood pressure and calculated end-systolic wall stress.

Main Results:

• Antihypertensive treatment significantly reduced blood pressure, end-systolic wall stress, and LV mass index.
• LVH regression was associated with increased midwall fractional shortening and decreased relative wall thickness.
• Improved midwall function persisted after treatment withdrawal, linked to preserved relative wall thickness despite increased wall stress.

Conclusions:

• Regression of concentric LVH is associated with improved midwall systolic function.
• Normalization of LV geometry, rather than solely the reduction in LV systolic stress, is the primary driver of improved systolic function.