Related Experiment Video
Updated: Jun 26, 2026
Echocardiographic Assessment of Cardiac Anatomy and Function in Adult Rats
Published on: December 13, 2019
Evaluation of systolic properties in hypertensive patients with different degrees of diastolic dysfunction and normal
Sebastiano Sciarretta1, Francesco Paneni, Giuseppino M Ciavarella
1Cardiology Department, II School of Medicine, University of Rome La Sapienza, S. Andrea Hospital, Rome, Italy.
Insights
Hypertension can cause early, preclinical systolic dysfunction even with normal ejection fraction and diastolic impairment. This reduction in systolic properties worsens with the severity of diastolic dysfunction.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Hypertension Research
Background:
- Left ventricular diastolic dysfunction (DD) in hypertensive patients with preserved ejection fraction (EF) is often viewed as isolated diastolic impairment.
- Systolic and diastolic functions are interconnected, suggesting potential early systolic abnormalities in severe DD.
- This study investigates preclinical systolic property changes in hypertensive individuals with varying degrees of DD and preserved EF.
Purpose of the Study:
- To assess left ventricular (LV) systolic properties using multiparametric echocardiography in hypertensive patients with preserved EF and different degrees of diastolic dysfunction.
- To determine if isolated DD is associated with early, preclinical reductions in LV systolic function.
- To explore the relationship between the severity of DD and the extent of systolic property impairment.
Main Methods:
- Evaluated 1,073 hypertensive subjects with EF >55% and no overt heart disease.
- Categorized patients into normal diastolic function (N), delayed relaxation (DR), and pseudonormal filling (PN) patterns.
- Utilized multiparametric echocardiography to assess various LV systolic indexes, including stroke volume, stroke work, midwall shortening, and tissue Doppler systolic velocity.
Main Results:
- While most patients with DD (DR, PN) had normal systolic indexes, they showed significant reductions in stroke volume, stroke work, EF, midwall shortening, and tissue Doppler systolic velocity compared to the normal group.
- The pseudonormal filling (PN) group exhibited the most pronounced reductions in systolic properties.
- Post-adjustment analysis confirmed a significant relationship between reduced LV systolic indexes and the presence and severity of DD, particularly the PN pattern.
Conclusions:
- LV systolic and diastolic properties are interrelated in hypertensive patients with normal EF.
- Early, preclinical reductions in systolic properties occur in patients with "isolated" DD, and these deficits correlate with the degree of diastolic dysfunction.
- These findings challenge the concept of isolated DD and highlight the systemic impact of hypertension on LV function.
Background:
Left ventricular (LV) diastolic dysfunction (DD) associated with a preserved ejection fraction (EF) is a frequent alteration in hypertensive patients, usually considered an impairment of the diastolic phase alone. However, because systole and diastole are strictly correlated to one another, it is possible that hypertensive patients with isolated DD may also present with initial abnormalities of LV systolic properties, particularly those presenting with a more severe degree of DD. We performed a multiparametric echocardiographic assessment of LV systolic properties in patients without cardiovascular diseases, with preserved EF and different degrees of DD.
Methods:
We evaluated 1,073 hypertensive subjects showing EF >55% and no overt heart disease.
Results:
A total of 362 patients had normal diastolic function (N), 609 displayed delayed relaxation pattern (DR), and 102 presented a pseudonormal filling pattern (PN). Albeit most of the subjects with DD (DR, PN) had systolic indexes within normal range, they presented a significant reduction of index stroke volume (SV) (P < 0.0001) and stroke work (SW) (P < 0.0001), EF (P < 0.01), midwall shortening (MFS) (P < 0.0001), circumferential end-systolic stress-corrected MFS (cESS-MFS) (P < 0.001), and tissue Doppler (TD) systolic velocity (P < 0.0001) as compared to the N group, particularly the PN group.After adjustments, the reductions of LV systolic indexes were still significantly related to DD, particularly to PN.
Conclusions:
Our results suggest a relation between LV systolic and diastolic properties in patients with normal EF. They also highlight the early onset of a preclinical reduction of systolic properties in patients with "isolated" DD, which is related to the degree of dysfunction.
Related Concept Videos
01:29Heart Failure II: Pathophysiology
01:30Hypertension III: Clinical Manifestations and Diagnostic Studies
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:17Pathophysiology of Heart Failure
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment: