Usefulness of Subnormal Midwall Fractional Shortening in Predicting Left Ventricular Exercise Dysfunction in Asymptomatic Patients With Systemic Hypertension

Schussheim, Adam E.; Devereux, Richard B.; Simone, Giovanni de; Borer, Jeffrey S.; Herrold, Edmund M.; Laragh, John H.

doi:10.1016/s0002-9149(97)00049-0

Cited by 45 publications

(34 citation statements)

References 26 publications

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“…A reduced midwall shortening has been shown to be associated with a lower exercise performance, 24 and although a parallel improvement is not necessarily implied, this is clearly a possibility. Furthermore, depressed midwall shortening has been shown to be an independent predictor of an adverse outcome in hypertensive subjects, particularly in subjects with additional LVH.…”

Section: Discussionmentioning

confidence: 99%

Improvement in Midwall Myocardial Shortening With Regression of Left Ventricular Hypertrophy

Mayet¹,

Ariff²,

Wasan³

et al. 2000

Hypertension

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Abstract-Despite normal indices of left ventricular (LV) chamber function, patients with LV hypertrophy (LVH) due to hypertension are thought to have depressed midwall systolic shortening compared with normotensives. The aims of the present study were (1) to confirm this observation and (2) to assess the effects of antihypertensive therapy that cause regression of LVH on LV systolic function assessed at both the midwall and endocardium. Thirty-eight previously untreated hypertensive subjects with LVH underwent echocardiography and were compared with 38 normotensive control subjects. Comparisons between the group with LVH and the control group revealed no significant differences in cardiac output (4.32Ϯ0.23 versus 4.55Ϯ0.21 L/min), ejection fraction (62.5Ϯ2% versus 66.4Ϯ1.07%), or endocardial fractional shortening (34.5Ϯ1.45% versus 37.0Ϯ0.82%), but shortening assessed at the midwall was significantly less in the group with LVH (17.9Ϯ1.11% versus 21.6Ϯ0.63%, PϽ0.01). Subsequently, 32 patients with uncontrolled hypertension (24 previously untreated and 8 on existing antihypertensive therapy) underwent treatment with ramipril, with the addition of felodipine and bendrofluazide if required, to reduce blood pressure to Ͻ140/90 mm Hg. These 32 patients underwent echocardiography at baseline, after blood pressure control, and after an additional 6 months of tight blood pressure control. Good blood pressure control was achieved after 6 months compared with baseline (

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Section: Discussionmentioning

confidence: 99%

Improvement in Midwall Myocardial Shortening With Regression of Left Ventricular Hypertrophy

Mayet¹,

Ariff²,

Wasan³

et al. 2000

Hypertension

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“…32 We have previously reported that hypertensive subjects with normal ejection fraction, but low resting midwall function had less ejection fraction increment during exercise. 33 Moreover, abnormal LV relaxation represents a common mechanism of heart failure in subjects with normal ejection fraction. 34,35 Interestingly, stress-corrected midwall shortening is more closely related than ejection fraction to LV relaxation parameters.…”

Section: Inappropriate LV Mass Lv Geometry and Lv Functionmentioning

confidence: 99%

Usefulness of the assessment of the appropriateness of left ventricular mass to detect left ventricular systolic and diastolic abnormalities in absence of echocardiographic left ventricular hypertrophy: the LIFE study

et al. 2004

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“…Many hypertensive patients have normal resting LV function but abnormal ejection fraction responses to exercise (44,75). We have found that abnormal exercise responses of both LV ejection fraction (46) and pulmonary capillary wedge pressure were associated with eccentric LV hypertrophy and with obesity, a cause of LV volume overload.…”

Section: Prognostic Implications Of Hypertensive Leftmentioning

confidence: 99%

“…However, a conceptual mismatch exists in analyses relating chamber size or shortening at the endocardium to the mean level of end-systolic wall stress, which is applied approximately at the LV midwall (74). When midwall-shortening-end-systolic stress relations were analyzed in relatively unselected hypertensive patients, patients with concentric LVH had decreased myocardial contractility and no significant hypercontractility was observed in patients without LVH (45).Many hypertensive patients have normal resting LV function but abnormal ejection fraction responses to exercise (44,75). We have found that abnormal exercise responses of both LV ejection fraction (46) and pulmonary capillary wedge pressure were associated with eccentric LV hypertrophy and with obesity, a cause of LV volume overload.…”

mentioning

confidence: 99%

Left Ventricular Hypertrophy in Hypertension: Stimuli, Patterns, and Consequences.

1999

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Left ventricular(LV) size in childhood closely parallels body size, whereas in adulthood LV mass is increasingly affected by effects of obesity, hypertension, the level of cardiac volume load, and the level of LV myocardial contractility.Recently, additional independent associations of diabetes, arterial structure and function and as yet unknown genes with higher LV mass have been defined; angiotensin II and insulin have also been suggested to be additive stimuli to LV hypertrophy.Consideration of the level of LV mass and of the LV wall thickness/ chamber radius ratio (relative wall thickness) has identified four different geometric patterns of LV adaptation to hypertension, including concentric LV hypertrophy (increased mass and wall thickness), eccentric hypertrophy (increased mass, normal relative wall thickness), concentric remodeling (increased relative wall thickness with normal mass) and normal LV geometry. Concentric hypertrophy is associated with especially high arterial pressure while eccentric hypertrophy is associated with obesity and elevated volume load. Numerous studies show that increased LV mass predicts cardiovascular events and death independently of all conventional risk factors; initial studies have also identified adverse implications of low LV midwall function and high relative wall thickness. Pioneer studies strongly suggest that reversal of LV hypertrophy is associated with an improved prognosis. (Hypertens Res 1999; 22: 1-9) Key Words: hypertension, echocardiography, left ventricular hypertrophy, left ventricular functionSince the mid 1970s, methods to measure left ventricular (LV) mass by echocardiography or by other techniques (1) have been used to show that LV hypertrophy (LVH) is more prevalent, more heterogeneous in its anatomic and pathophysiologic patterns, and a stronger determinant of outcome in hypertensive patients than was previously recognized. In this article, we will examine stimuli of hypertensive LVH, review its geometric patterns, and discuss the consequences of LVH with respect to cardiac function and outcome. Stimuli PromotingThe LV normally grows continuously from infancy until adulthood (2), with cellular enlargement (hypertrophy) accounting for most of the increase in size. Further increases, or at times decreases, in LV muscle mass may occur due to physiologic or pathologic alterations in hemodynamic load. In apparently normal individuals, the closest correlate of LV mass is body size in both children and adults (2-3). Body size has traditionally been taken into account by indexing LV mass for body surface area. This method of LV mass indexation is useful in detecting LVH due to hypertension, but may misclassify obesity-induced LVH as normal (4). A physiologic approach to the problem imposed by obesity is to index LV mass for lean body mass (5), but this is impractical for routine purposes. Alternatively, body height to the power of its allometric (or growth) relationship with LV mass can be used to index the latter variable (6). After puberty, men have a lar...

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Usefulness of Subnormal Midwall Fractional Shortening in Predicting Left Ventricular Exercise Dysfunction in Asymptomatic Patients With Systemic Hypertension

Cited by 45 publications

References 26 publications

Improvement in Midwall Myocardial Shortening With Regression of Left Ventricular Hypertrophy

Improvement in Midwall Myocardial Shortening With Regression of Left Ventricular Hypertrophy

Usefulness of the assessment of the appropriateness of left ventricular mass to detect left ventricular systolic and diastolic abnormalities in absence of echocardiographic left ventricular hypertrophy: the LIFE study

Left Ventricular Hypertrophy in Hypertension: Stimuli, Patterns, and Consequences.

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