Left ventricular dyssynchrony in hypertensive patients without congestive heart failure

Normal left ventricular (LV) systolic function is present in as many as 50% of patients with congestive heart failure. The majority of such patients have systemic hypertension. Recent studies have demonstrated LV dyssynchrony among patients with heart failure and normal systolic function. However, it is unclear whether such abnormalities exist in hypertensive patients who have not developed clinical evidence of heart failure.

Hospitalized patients with established hypertension undergoing echocardiography who met the following criteria were eligible for the study: LV ejection fraction (EF) >or= 50%, wall >or=11 mm, absence of valvular or known ischemic disease, and normal QRS duration. Complete 2-Dimensional and Doppler echocardiography studies with tissue Doppler imaging (TDI) were performed in all patients. Dyssynchrony was measured using time from QRS to peak systolic velocity on TDI (T-P) in 3 apical views. Normal values for dyssynchrony were established in a group of normotensive patients with normal echocardiography studies.

The study included 42 patients (19 women, 23 men with a, mean age of 59.6 y (range 32-96 y). Left ventricular dyssynchrony was common, occurring in 20 of 42 patients (47.6%). Dyssynchrony assessed with the maximum T-P (T-Pmax) was significantly related to LV mass (r = 0.32, p = 0.036), left atrial volume (r = 0.59, p < 0.0001), and LV sphericity index (0.32, p = 0.037). Dyssynchrony was not related to age or LV filling pressure calculated from the Doppler study.

Left ventricular dyssynchrony is common among hypertensive patients with normal LV systolic function and no evidence of congestive heart failure. The severity of LV dyssynchrony is related to the magnitude of LV hypertrophy, left atrial size, and LV remodeling.