Evaluation of midwall systolic function in left ventricular hypertrophy: a comparison of 3-dimensional versus...

This study investigated the sensitivity of 3-dimensional (3D) midwall ejection fraction (EF) (3DEF(mw)) to the presence of left ventricular (LV) hypertrophy (LVH) in comparison with conventional echocardiographic indices for systolic function.

EF and fractional shortening (FS) do not reflect the prognosis of patients with LVH. Midwall mechanics better represent the true function in LVH. However, midwall FS (FS(mw)) interrogates a limited region of LV. We developed a method for determining 3DEF(mw).

This study compared 3DEF(mw) with 2-dimensional (endocardial EF [EF(endo)], endocardial FS, FS(mw), and systolic tissue velocity) and 3D (3D EF(endo) and mitral annular motion [MAM]) echocardiographic indices in 28 patients with essential hypertension and LV mass index by M-mode greater than 125 g/m(2) versus 21 healthy individuals.

Systolic function assessed by EF(endo), endocardial FS, 3D EF(endo), and systolic tissue velocity did not differ between the two groups, but MAM (11.6 vs 14.0 mm), FS(mw) (14.7 vs 18.2%), and 3DEF(mw) (36.6 vs 44.1%) were significantly decreased in LVH compared with normal. Only 3 parameters correlated significantly with both the M-mode and 3D measurements of LV mass index: FS(mw) (r = -0.74 [M-mode]; r = -0.48 [3D]), 3DEF(mw) (r = -0.63 [M-mode]; r = -0.68 [3D]), and MAM (r = -0.43 [M-mode]; r = -0.36 [3D]). Midwall indices FS(mw) (F = 40.4) and 3DEF(mw) (F = 26.5) better discriminated LVH and normal groups than MAM or endocardial indices.

The 3DEF(mw) method discriminates the systolic function of LVH and normal groups, and correlates with the degree of hypertrophy. By avoiding the limitations of FS(mw) or MAM, 3DEF(mw) provides a more comprehensive metric of systolic function in patients with LVH.