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Left ventricular mass and systolic performance in chronic systemic hypertension
Insights
Left ventricular (LV) hypertrophy in chronic systemic hypertension correlates with impaired systolic performance. As LV mass increases, LV dysfunction becomes more prevalent, indicating intrinsic myocardial contractile deficits.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Chronic systemic hypertension frequently leads to left ventricular (LV) hypertrophy.
- The relationship between the degree of LV hypertrophy and systolic function requires further elucidation.
Purpose of the Study:
- To define the relationship between the extent of left ventricular (LV) hypertrophy and ventricular systolic performance in patients with chronic systemic hypertension.
Main Methods:
- Ninety hypertensive patients were compared to 41 normal subjects.
- LV mass was assessed using M-mode echocardiography.
- Systolic performance was evaluated using pre-ejection period to LV ejection time ratio (PEP/LVET), percent shortening (% delta D), and velocity of circumferential shortening (Vcf).
Main Results:
- LV dysfunction increased with LV mass, with abnormalities noted in 33% (PEP/LVET), 15% (% delta D), and 0% (Vcf) in mild hypertrophy (Group I).
- In moderate to severe hypertrophy (Groups II and III), abnormalities rose to 55-85% (PEP/LVET), 35-72% (% delta D), and 15-55% (Vcf).
- Hypertrophy was appropriate to wall tension in mild to moderate cases (Groups I and II).
Conclusions:
- LV dysfunction in patients with moderate LV hypertrophy reflects intrinsic contractile deficiencies of the hypertrophied myocardium.
- The findings highlight the impact of increasing LV mass on myocardial function in hypertensive patients.
Abstract:
This study was undertaken to define the relation between the extent of left ventricular (LV) hypertrophy and ventricular systolic performance in patients with chronic systemic hypertension. Ninety patients with chronic systemic hypertension were compared with 41 normal subjects as determined by angiography. LV mass was estimated from the M-mode echocardiogram. Patients were separated into 3 groups: those with LV mass of less than 2 (group I, n = 58), 2 to 4 (group II, n = 21) and more than 4 (group III, n = 11) standard deviations above mean normal. The ratio of preejection period to LV ejection time (PEP/LVET), percent shortening of the echocardiographic internal diameter (% delta D) and velocity of circumferential shortening (Vcf) were used as indexes of LV systolic performance. The frequency of abnormality, expressed as percent of patients in groups I, II and III, was 33%, 55% and 85% for PEP/LVET, 15%, 35% and 72% for % delta D, and 0%, 15% and 55% for Vcf. For each group PEP/LVET was the most frequently abnormal measure and Vcf was the least frequent abnormality. Calculation of peak and end-systolic wall stress was used as an index of the adequacy of LV hypertrophy. This index was significantly reduced in group I, did not differ from control in group II and was significantly increased in group III, indicating that hypertrophy was appropriate to wall tension in groups I and II. It is concluded that the occurrence of LV dysfunction with increasing LV mass in patients with moderate LV hypertrophy (group I and II) reflects a deficiency in intrinsic contractile performance of the hypertrophied myocardium.(ABSTRACT TRUNCATED AT 250 WORDS)