Diastolic Function in Hypertensive Patients with Basal Septal Hypertrophy Assessed by Conventional Methods and...

Objectives: To investigate early alterations in left ventricular (LV) diastolic function in young patients with uncomplicated arterial hypertension and basal septal hypertrophy (BSH), preserved LV ejection fraction (LVEF), and no overt cardiovascular comorbidities. Methods: Patients were divided into two groups according to the presence or absence of BSH and compared. Conventional diastolic assessment according to current recommendations were performed, along with two-dimensional speckle-tracking echocardiography for LV systolic and diastolic deformation and LA reservoir strain (LARS). Results: A total of 138 patients were included; 53.6% had BSH. For the whole population LV systolic and diastolic function were preserved, and overall LV geometry parameters and LA dimensions and function were within normal limits. However, patients with BSH were found to have more pronounced geometry changes in terms of concentric remodeling beyond BSH (LVMI 109.15 ± 25.33 vs. 89.19 ± 24.59 g/m², p < 0.001; RWT 0.38 ± 0.11 vs. 0.3 ± 0.08, p < 0.001), LA dilation (32.68 ± 9.98 vs. 30.03 ± 11.37, p = 0.05), and impaired LV relaxation according to standard parameters (E wave 0.72 ± 0.18 vs. 0.79 ± 0.2 m/s, p = 0.05; A wave 0.76 ± 0.14 vs. 0.72 ± 0.19 m/s, p = 0.04; E/A 0.96 ± 0.28 vs. 1.16 ± 0.39, p = 0.001; e' septal 0.08 ± 0.02 vs. 0.1 ± 0.02 m/s, p = 0.001; and e' lateral 0.12 ± 0.03 vs. 0.15 ± 0.04 m/s, p = 0.001) and diastolic strain rate (SR) (SRe 1.17 ± 0.35 vs. 1.31 ± 0.35%/s, p = 0.02; SRe/SRa 1.39 ± 0.63 vs. 1.69 ± 0.89, p = 0.03). Measurement of the diastolic SR was feasible in 97.1% of the patients with good reproducibility and interobserver difference of 1.28%. Significant correlations were found between basal septal thickness and parameters of LV and LA remodeling and diastolic function. Conclusions: Basal septal hypertrophy appears to represent an early, functionally relevant stage of hypertensive myocardial remodeling rather than an isolated morphological finding. Even in the presence of preserved LVEF, BSH is associated with subtle impairment of LV relaxation. Deformation imaging may improve identification of patients at risk for progression toward overt diastolic dysfunction and heart failure with preserved ejection fraction.