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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
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Evaluation of Left Ventricular Structure and Function using 3D Echocardiography

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Association of left ventricular longitudinal and circumferential systolic dysfunction with diastolic function in

Piercarlo Ballo1, Stefano Nistri2, Matteo Cameli3

  • 1Cardiology Unit, S Maria Annunziata Hospital, Florence, Italy.

Journal of Cardiac Failure
|December 24, 2013
PubMed

Insights

Left ventricular diastolic function in hypertensive patients is linked to longitudinal systolic dysfunction, not circumferential. Impaired longitudinal function influences how heart structure affects diastolic performance, suggesting a reevaluation of isolated diastolic dysfunction.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Hypertension Research

Background:

  • Hypertension commonly affects left ventricular (LV) function.
  • The comparative impact of longitudinal versus circumferential systolic dysfunction on diastolic function in hypertensive patients remains unclear.

Purpose of the Study:

  • To compare the relationships between LV longitudinal and circumferential systolic dysfunction and diastolic performance in hypertensive patients.
  • To investigate the independent association of systolic dysfunction patterns with diastolic function parameters.

Main Methods:

  • 532 asymptomatic hypertensive patients were studied.
  • Longitudinal function assessed by left atrioventricular plane displacement (AVPD) and systolic mitral annular velocity (s').
  • Circumferential function assessed by midwall fractional shortening (mFS) and stress-corrected mFS (SCmFS). Diastolic function evaluated using early diastolic annular velocity (e') and E/e' ratio. Global strains analyzed in a subset.

Main Results:

  • Early diastolic annular velocity (e') correlated significantly with all systolic indexes, but more strongly with longitudinal measures (AVPD, s') than circumferential (mFS, SCmFS).
  • The E/e' ratio showed nonlinear relationships with longitudinal indexes (AVPD, s') but no significant association with circumferential indexes (mFS, SCmFS).
  • Longitudinal indexes were superior in predicting specific diastolic dysfunction thresholds and remained independently associated with diastolic parameters in multivariable analyses.

Conclusions:

  • Left ventricular diastolic performance in hypertensive individuals is independently associated with longitudinal systolic dysfunction, not circumferential.
  • Subtle longitudinal systolic impairment mediates the influence of LV geometry on diastolic performance.
  • Findings suggest a need to revise the concept of isolated diastolic dysfunction in hypertensive patients.
Abstract

Keywords:
Systolediastolic dysfunctionhypertensionspeckle trackingtissue Doppler imaging

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