Related Experiment Videos
Systolic function in hypertensive men with concentric remodeling
D B Sadler1, G P Aurigemma, D W Williams
1Division of Cardiology of the University of Massachusetts Medical Center, Worcester 01655, USA.
Insights
Hypertensive men with concentric remodeling show reduced systolic function, including lower stroke volume and impaired myocardial function, indicating potential health risks despite normal chamber function. This highlights the need for careful assessment in these patients.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Hypertensive patients with concentric remodeling may experience adverse outcomes.
- Systolic function abnormalities are known in concentric left ventricular (LV) hypertrophy but are unclear in concentric remodeling.
Purpose of the Study:
- To evaluate left ventricular (LV) pump, chamber, and myocardial function in hypertensive men with concentric remodeling.
- To compare these functions against hypertensive men with normal LV geometry.
Main Methods:
- Clinical and echocardiographic data from 118 hypertensive men with concentric remodeling and 104 controls were analyzed.
- LV chamber function assessed via endocardial fractional shortening to stress.
- Myocardial function assessed via midwall fractional shortening to stress; pump performance by stroke volume.
Main Results:
- Concentric remodeling patients had lower stroke volume (84 vs. 111 mL, P < .001).
- Midwall shortening was reduced (20% vs. 22%, P < .001) despite lower stress (81 vs. 117 g/cm2, P < .001).
- 28% and 42% of remodeling patients had impaired endocardial and midwall function, respectively.
Conclusions:
- Hypertensive men with concentric remodeling exhibit lower chamber, myocardial, and pump performance than those with normal geometry.
- These findings suggest potential systolic function abnormalities in men with concentric remodeling.
Abstract:
Hypertensive patients with concentric remodeling (relative wall thickness > or = 0.45 and normal left ventricular [LV] mass index) may have poor outcomes. It is unclear whether systolic function abnormalities, shown to be present in some patients with concentric LV hypertrophy (increased LV mass index and relative wall thickness > or = 0.45), are also present in patients with concentric remodeling. To assess LV pump, chamber, and myocardial function in hypertensive men with concentric remodeling, clinical and echocardiographic data of 118 hypertensive men with concentric remodeling were compared with data from 104 hypertensive men with normal relative wall thickness and normal LV mass index. Chamber function was assessed by relating endocardial fractional shortening to end-systolic circumferential stress, myocardial function was assessed by relating midwall fractional shortening to circumferential stress, and pump performance was assessed by stroke volume (Teichholz method). Compared with hypertensive men with normal relative wall thickness, concentric-remodeling patients had lower stroke volume (84 +/- 20 versus 111 +/- 20 mL, P < .001). Endocardial shortening was no different between the two groups (38 +/- 7% versus 40 +/- 7%, P=NS), but midwall shortening was lower in patients with concentric remodeling (20 +/- 3% versus 22 +/- 3%, P < .001), despite lower end-systolic stress (81 +/- 25 versus 117 +/- 37 g/cm2, P < .001). Endocardial and midwall stress-shortening regression plots classified 28% and 42%, respectively, of the concentric remodeling patients below the fifth percentile of hypertensive patients with normal geometry. These data indicate that indexes of chamber and myocardial function are lower than those observed in hypertensive patients with normal geometry. Thus, indices of chamber, myocardial, and pump performance indicate potential abnormalities in systolic function in men with concentric remodeling.