Our results revealed that the major differences between ADD and DHF were global and longitudinal LV systolic dysfunction and LV enlargement. This study suggests that LV systolic dysfunction plays an important role in the development of DHF.
Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp ssential hypertension is a major risk factor for cardiovascular disease. In hypertensive patients, pressure and/or volume overload leads to left ventricular (LV) hypertrophy, which is a powerful independent predictor of morbidity and mortality. 1 Hypertensive LV hypertrophy causes heart failure, especially diastolic heart failure, which is heart failure with a normal LV ejection fraction (LVEF) because of LV diastolic dysfunction. However, several studies have reported that patients with diastolic heart failure have not only diastolic dysfunction but also systolic dysfunction, when parameters other than LVEF were used to evaluate systolic function. 2-5 Therefore, global cardiac function including systolic and diastolic LV function should be evaluated by non-conventional functional parameters such as the Tei index. The Tei index, combining systolic and diastolic functional parameters, may be a better and simpler parameter to estimate LV global function than conventional indices of purely systolic or diastolic function in hypertensive patients.Based on LV mass and relative wall thickness, patients with essential hypertension can be classified into 4 different LV geometric patterns: normal, concentric remodeling, concentric hypertrophy and eccentric hypertrophy. 6-8 Previous studies have reported that abnormal LV geometric patterns are associated with a greater risk of hypertensive complications, and patients with concentric LV hypertrophy have the highest mortality and cardiovascular event rate. 7,9 The relation between these 4 different LV geometric patterns and LV function has not been elucidated. Therefore, we aimed to investigate the correlation Background: Left ventricular (LV) hypertrophy is a powerful independent predictor of morbidity and mortality in hypertensive patients. Abnormal LV geometric patterns are also associated with hypertensive complications, and concentric hypertrophy is associated with the highest mortality in hypertensive patients. However, the relationship between geometric patterns and cardiac dysfunction is not fully established. We hypothesized that the Tei index, which is a measure of global cardiac function, is a feasible parameter for estimating cardiac dysfunction among the different LV geometric patterns in hypertensive patients.
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Regional left ventricular (LV) systolic dysfunction has been identified in diastolic heart failure (DHF). However, the relationship between regional or global LV systolic function and heart failure symptoms in DHF has not been evaluated in detail. The present study evaluates such relationships in patients with systemic hypertension (HT) and DHF. We assessed LV systolic and diastolic function in 220 consecutive patients with systemic HT and in 30 normal individuals (Control) using Doppler echocardiography. Patients with HT were assigned to groups with DHF, asymptomatic diastolic dysfunction (ADD) and no diastolic dysfunction (Simple HT). Ejection fraction in DHF was significantly decreased (63 ± 8%) compared with the Control, Simple HT and ADD groups (67±5, 66±7 and 68±8%, respectively). Isovolumetric contraction time in DHF (70±30 msec) was significantly increased compared with those in the ADD, Simple HT and Control groups (31±17, 31±15 and 30±19 msec, respectively). Mitral annular systolic velocities were significantly decreased in the DHF and ADD groups (6.4 ± 1.5 and 7.2 ± 1.3 cm sec À1 , respectively) compared with those in the Simple HT and Control groups (8.5 ± 1.8 and 8.4 ± 3.0 cm sec À1 , respectively), and in the DHF group compared with the ADD group. LV global systolic dysfunction has a significant role in the development of heart failure symptoms associated with DHF in patients with systemic HT.
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