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Could early septal involvement in the remodeling process be related to the advance hypertensive heart disease?
Fatih Yalçin1,2, Caner Topaloglu2, Nagehan Kuçukler1,2
1Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD, United States.
Insights
Hypertension significantly impacts myocardial performance, particularly in the septal wall, even before left ventricular hypertrophy (LVH) develops. Septal myocardial performance index (MPI) abnormalities correlate with septal wall thickness in hypertensive patients.
Area of Science:
- Cardiovascular Imaging
- Hypertension Research
- Myocardial Mechanics
Background:
- Quantitative imaging suggests earlier septal wall involvement in hypertension.
- Hypertension is a significant risk factor for cardiovascular disease, affecting cardiac structure and function.
Purpose of the Study:
- To investigate the effect of hypertension on regional myocardial performance index (MPI).
- To assess differences in myocardial performance between hypertensive patients with and without left ventricular hypertrophy (LVH).
Main Methods:
- Evaluated 119 hypertensive patients (57 without LVH, 62 with LVH) and 37 healthy controls.
- Utilized conventional and tissue Doppler imaging to assess cardiac function.
- Measured parameters including contraction time (CT), isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT), and MPI.
Main Results:
- Left ventricular (LV) mass index was significantly higher in hypertensive patients with LVH.
- Septal and lateral MPI were abnormal in both hypertensive groups compared to controls (p < 0.0001).
- Septal MPI showed a moderate correlation with septal wall thickness (r = 0.447, p < 0.001).
Conclusions:
- Hypertension adversely affects septal myocardial performance more than lateral myocardial performance, even in the absence of LVH.
- LV diastolic dysfunction is more pronounced in the septal wall compared to the lateral wall in hypertensive patients with LVH.
- Early septal involvement in hypertension may explain the dominant impact on septal myocardial function.
Background:
Quantitative imaging analyses showed an earlier septal wall involvement in hypertension. We planned to determine the effect of hypertension on regional myocardial performance index (MPI) in a hypertensive patient population.
Methods:
We evaluated 119 hypertensive patients who were divided into gr. I: 57 patients without left ventricular hypertrophy (LVH), (53.1 ± 10 years), and gr. II: 62 patients with LVH (55.1 ± 9 years) using conventional and tissue doppler imaging. They were compared with gr. III, a sex-age-matched normal control group (37 subjects, 53.0 ± 10 years).
Results:
We detected basal septal and basal lateral contraction time (CT), isovolumetric CT and relaxation time (IVRT) and MPI. EF was 68 ± 5 % in gr. I, 69 ± 5 % in gr. II, 69 ± 4 % in gr. III. LV mass index was 122 ± 11 g/m2 in gr. I, 148 ± 13 g/m2 in gr. II and 118 ± 13 g/m2 in gr. III. Concentric LVH was detected in gr. II (relative wall thickness = 0.49 ± 0.8). LV septal and lateral MPI were abnormal in both hypertensive groups (p < 0.0001). Septal MPI was correlated moderately with septal wall thickness (r = 0.447, p < 0.001).
Conclusions:
LV diastolic dysfunction becomes more severe in septal wall than lateral wall in hypertensive LVH. Septal myocardial performance is more dominantly affected by hypertension possibly due to earlier septal involvement in disease course. Septal MPI is correlated moderately with septal wall thickness.
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