Systolic Function in Hypertensive 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.

Mechanisms leading to reversible mechanical dysfunction in severe CAD: alternatives to myocardial stunning

“…Regional ejection fraction showed a significant inverse correlation with regional loading, suggesting that regional mechanical performance decreases as regional wall stress increases (135). Inverse correlations between regional parameters of systolic function and wall stress were similarly reported in patients with first-reperfused MI (with use of 3-dimensional MRI) (38), in patients with known or suspected CAD (with use of echocardiography) (172), and in hypertensive patients with concentric remodeling (with use of echocardiography) (139). The explanation for such observations is unclear, and further studies are necessary to correctly interpret these correlations in patients presenting ischemic or hypertrophic territories, in which systolic function is also influenced by factors other than wall stress.…”

Left ventricular mass and systolic dysfunction in essential hypertension

“…1,[9][10][11] However, the strongest correlate of midwall function is LV geometric pattern, concentric geometry (expressed as relative wall thickness) being a powerful determinant of reduced midwall function. 6,12,13 A marked increase in relative wall thickness was recently reported in 42 hypertensive patients with depressed LV midwall function compared with 117 hypertensive subjects with normal midwall function, even in the absence of differences in LV mass between the groups. 14 However, the confounding effect of LV geometric pattern on the relation between LV mass and systolic function has never been examined.…”

Hypertension and heart failure: a dysfunction of systole, diastole or both?

“…Earlier prospective studies have demonstrated that hypertension-related concentric remodelling is associated with adverse cardiovascular outcomes, including myocardial infarction, heart failure and increased mortality. 35,[50][51][52][53] Despite normal LV ejection fraction and unchanged endocardial stress-shortening relationship in concentric LVH, a subtle systolic dysfunction can be demonstrated by depressed LV midwall fractional shortening on traditional two-dimensional echocardiography [51][52][53][54] and tagged cardiac magnetic resonance 55 and, more recently, abnormalities of LV long and short axes by tissue Doppler and strain echocardiography. [56][57][58] In contrast, eccentric remodelling is associated with volume overload and involves the addition of sarcomeres in series to achieve myocyte lengthening.…”