Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension

Division of Cardiology, New York Hospital, Cornell Medical Center, New York 10021.

OBJECTIVES. This study examined left ventricular performance in relatively unselected hypertensive patients by use of physiologically appropriate midwall shortening/end-systolic stress relations. BACKGROUND. Supranormal left ventricular function has been reported in hypertensive patients, possibly due to an artifact of mismatching endocardial rather than midwall fractional shortening to mean left ventricular end-systolic stress. METHODS. Samples of 474 hypertensive patients (150 women, 324 men) and 140 normal subjects (68 women, 72 men) were drawn from a large urban employed population. The inverse relations (p < 0.0001) of both echocardiographic endocardial and midwall fractional shortening to end-systolic stress in normal subjects were used to calculate the ratios of observed to predicted endocardial and midwall fractional shortening in hypertensive patients. Midwall shortening was calculated from an elliptic model, taking into account the epicardial migration of the midwall during systole. RESULTS. Use of midwall fractional shortening in hypertensive patients reduced the proportion of patients with function above the 95th percentile of normal from 22% to 4% (p < 0.0001) and fractional shortening as a percent of predicted from 107% (p < 0.001 vs. 100% in normotensive control subjects) to 95% (p < 0.0001; p < 0.001 vs. 101% in normotensive control subjects). Midwall shortening was below the 5th percentile of normal in 16% of hypertensive patients instead of 2% with endocardial shortening (p < 0.0001): They tended to be older than other hypertensive patients and had concentric left ventricular hypertrophy. Among hypertensive patients, those with concentric left ventricular hypertrophy or remodeling had reduced midwall shortening as a percent of predicted from end-systolic stress (p < 0.0001). CONCLUSIONS. Use of the physiologically more appropriate midwall shortening/end-systolic stress relation 1) markedly reduces the proportion of hypertensive subjects identified as having high endocardial left ventricular function; and 2) identifies a substantial subgroup of patients with reduced left ventricular function who have concentric geometry of the left ventricle, a pattern associated with high cardiovascular risk.

This article has been cited by other articles:

				A. Sharp, R. Tapp, D. P. Francis, S. A. McG. Thom, A. D. Hughes, A. V. Stanton, A. Zambanini, N. Chaturvedi, S. Byrd, N. R. Poulter, et al. Ethnicity and Left Ventricular Diastolic Function in Hypertension: An ASCOT (Anglo-Scandinavian Cardiac Outcomes Trial) Substudy J. Am. Coll. Cardiol., September 16, 2008; 52(12): 1015 - 1021. [Abstract] [Full Text] [PDF]

				A. Kiotsekoglou, A. Bajpai, B. H. Bijnens, V. Kapetanakis, G. Athanassopoulos, J. C. Moggridge, M. J. Mullen, D. K. Nassiri, J. Camm, G. R. Sutherland, et al. Early impairment of left ventricular long-axis systolic function demonstrated by reduced atrioventricular plane displacement in patients with Marfan syndrome Eur J Echocardiogr, September 1, 2008; 9(5): 605 - 613. [Abstract] [Full Text] [PDF]

				R. W.W. Biederman, M. Doyle, A. A. Young, R. B. Devereux, E. Kortright, G. Perry, J. N. Bella, S. Oparil, D. Calhoun, G. M. Pohost, et al. Marked Regional Left Ventricular Heterogeneity in Hypertensive Left Ventricular Hypertrophy Patients: A Losartan Intervention for Endpoint Reduction in Hypertension (LIFE) Cardiovascular Magnetic Resonance and Echocardiographic Substudy Hypertension, August 1, 2008; 52(2): 279 - 286. [Abstract] [Full Text] [PDF]

				A. Baltabaeva, M. Marciniak, B. Bijnens, J. Moggridge, F. J. He, T. F. Antonios, G. A. MacGregor, and G. R. Sutherland Regional left ventricular deformation and geometry analysis provides insights in myocardial remodelling in mild to moderate hypertension Eur J Echocardiogr, July 1, 2008; 9(4): 501 - 508. [Abstract] [Full Text] [PDF]

				K. Wachtell Left ventricular systolic performance in asymptomatic aortic stenosis Eur. Heart J. Suppl., July 1, 2008; 10(suppl_E): E16 - E22. [Abstract] [Full Text] [PDF]

				E. Gerdts, D. Cramariuc, G. de Simone, K. Wachtell, B. Dahlof, and R. B. Devereux Impact of left ventricular geometry on prognosis in hypertensive patients with left ventricular hypertrophy (the LIFE study) Eur J Echocardiogr, May 13, 2008; (2008) jen155v1. [Abstract] [Full Text] [PDF]

				E. Gerdts, P. M. Okin, G. de Simone, D. Cramariuc, K. Wachtell, K. Boman, and R. B. Devereux Gender Differences in Left Ventricular Structure and Function During Antihypertensive Treatment: The Losartan Intervention for Endpoint Reduction in Hypertension Study Hypertension, April 1, 2008; 51(4): 1109 - 1114. [Abstract] [Full Text] [PDF]

				C. Catena, G. Colussi, R. Lapenna, E. Nadalini, A. Chiuch, P. Gianfagna, and L. A. Sechi Long-Term Cardiac Effects of Adrenalectomy or Mineralocorticoid Antagonists in Patients With Primary Aldosteronism Hypertension, November 1, 2007; 50(5): 911 - 918. [Abstract] [Full Text] [PDF]

				M. Chinali, G. de Simone, M. C. Matteucci, S. Picca, A. Mastrostefano, A. Anarat, S. Caliskan, N. Jeck, T. J. Neuhaus, A. Peco-Antic, et al. Reduced Systolic Myocardial Function in Children with Chronic Renal Insufficiency J. Am. Soc. Nephrol., February 1, 2007; 18(2): 593 - 598. [Abstract] [Full Text] [PDF]

				E. Avelar, T. V. Cloward, J. M. Walker, R. J. Farney, M. Strong, R. C. Pendleton, N. Segerson, T. D. Adams, R. E. Gress, S. C. Hunt, et al. Left Ventricular Hypertrophy in Severe Obesity: Interactions Among Blood Pressure, Nocturnal Hypoxemia, and Body Mass Hypertension, January 1, 2007; 49(1): 34 - 39. [Abstract] [Full Text] [PDF]

				V. Palmieri, C. Russo, E. Arezzi, S. Pezzullo, M. Sabatella, S. Minichiello, and A. Celentano Relations of longitudinal left ventricular systolic function to left ventricular mass, load, and Doppler stroke volume Eur J Echocardiogr, October 1, 2006; 7(5): 348 - 355. [Abstract] [Full Text] [PDF]

				M. Chinali, G. de Simone, M. J. Roman, E. T. Lee, L. G. Best, B. V. Howard, and R. B. Devereux Impact of Obesity on Cardiac Geometry and Function in a Population of Adolescents: The Strong Heart Study J. Am. Coll. Cardiol., June 6, 2006; 47(11): 2267 - 2273. [Abstract] [Full Text] [PDF]

				P. Narayan, V. Papademetriou, K. Wachtell, E. Gerdts, K. Boman, M. S. Nieminen, G. de Simone, B. Dahlof, F. Fyhrquist, A. Hoieggen, et al. Association of Hemoglobin Delivery With Left Ventricular Structure and Function in Hypertensive Patients: Losartan Intervention For End Point Reduction in Hypertension Study Hypertension, May 1, 2006; 47(5): 868 - 873. [Abstract] [Full Text] [PDF]

				S. Klotz, I. Hay, G. Zhang, M. Maurer, J. Wang, and D. Burkhoff Development of Heart Failure in Chronic Hypertensive Dahl Rats: Focus on Heart Failure With Preserved Ejection Fraction Hypertension, May 1, 2006; 47(5): 901 - 911. [Abstract] [Full Text] [PDF]

				M. C. C. Borges, R. C.R. Colombo, J. G. F. Goncalves, J. d. O. Ferreira, and K. G. Franchini Longitudinal Mitral Annulus Velocities Are Reduced in Hypertensive Subjects With or Without Left Ventricle Hypertrophy Hypertension, May 1, 2006; 47(5): 854 - 860. [Abstract] [Full Text] [PDF]

				R. M. Lang, M. Bierig, R. B. Devereux, F. A. Flachskampf, E. Foster, P. A. Pellikka, M. H. Picard, M. J. Roman, J. Seward, J. Shanewise, et al. Recommendations for chamber quantification Eur J Echocardiogr, March 1, 2006; 7(2): 79 - 108. [Abstract] [Full Text] [PDF]

				R. W.W. Biederman, M. Doyle, J. Yamrozik, R. B. Williams, V. K. Rathi, D. Vido, K. Caruppannan, N. Osman, V. Bress, G. Rayarao, et al. Physiologic Compensation Is Supranormal in Compensated Aortic Stenosis: Does it Return to Normal After Aortic Valve Replacement or Is it Blunted by Coexistent Coronary Artery Disease?: An Intramyocardial Magnetic Resonance Imaging Study Circulation, August 30, 2005; 112(9_suppl): I-429 - I-436. [Abstract] [Full Text] [PDF]

				K. Berenji, M. H. Drazner, B. A. Rothermel, and J. A. Hill Does load-induced ventricular hypertrophy progress to systolic heart failure? Am J Physiol Heart Circ Physiol, July 1, 2005; 289(1): H8 - H16. [Abstract] [Full Text] [PDF]

				B. Capaldo, M. Galderisi, A. A. Turco, A. D'Errico, S. Turco, A. A. Rivellese, G. de Simone, O. de Divitiis, and G. Riccardi Acute Hyperglycemia Does Not Affect the Reactivity of Coronary Microcirculation in Humans J. Clin. Endocrinol. Metab., July 1, 2005; 90(7): 3871 - 3876. [Abstract] [Full Text] [PDF]

				M. Kozakova, A. G. Fraser, S. Buralli, A. Magagna, A. Salvetti, E. Ferrannini, and C. Palombo Reduced Left Ventricular Functional Reserve in Hypertensive Patients With Preserved Function at Rest Hypertension, April 1, 2005; 45(4): 619 - 624. [Abstract] [Full Text] [PDF]

				P. Verdecchia, F. Angeli, R. Gattobigio, M. Sardone, and C. Porcellati Asymptomatic Left Ventricular Systolic Dysfunction in Essential Hypertension: Prevalence, Determinants, and Prognostic Value Hypertension, March 1, 2005; 45(3): 412 - 418. [Abstract] [Full Text] [PDF]

				G. de Simone, S. R. Daniels, T. R. Kimball, M. J. Roman, C. Romano, M. Chinali, M. Galderisi, and R. B. Devereux Evaluation of Concentric Left Ventricular Geometry in Humans: Evidence for Age-Related Systematic Underestimation Hypertension, January 1, 2005; 45(1): 64 - 68. [Abstract] [Full Text] [PDF]

				P. M. Mottram, B. Haluska, R. Leano, D. Cowley, M. Stowasser, and T. H. Marwick Effect of Aldosterone Antagonism on Myocardial Dysfunction in Hypertensive Patients With Diastolic Heart Failure Circulation, August 3, 2004; 110(5): 558 - 565. [Abstract] [Full Text] [PDF]

				G. Pela, G. Regolisti, P. Coghi, A. Cabassi, A. Basile, A. Cavatorta, C. Manca, and A. Borghetti Effects of the reduction of preload on left and right ventricular myocardial velocities analyzed by Doppler tissue echocardiography in healthy subjects Eur J Echocardiogr, August 1, 2004; 5(4): 262 - 271. [Abstract] [Full Text] [PDF]

				E. Abergel, G. Chatellier, A. A. Hagege, A. Oblak, A. Linhart, A. Ducardonnet, and J. Menard Serial left ventricular adaptations in world-class professional cyclists: Implications for disease screening and follow-up J. Am. Coll. Cardiol., July 7, 2004; 44(1): 144 - 149. [Abstract] [Full Text] [PDF]

				M. H. Drazner, J. E. Rame, E. K. Marino, J. S. Gottdiener, D. W. Kitzman, J. M. Gardin, T. A. Manolio, D. L. Dries, and D. S. Siscovick Increased left ventricular mass is a risk factor for the development of a depressed left ventricular ejection fraction within five years: The Cardiovascular Health Study J. Am. Coll. Cardiol., June 16, 2004; 43(12): 2207 - 2215. [Abstract] [Full Text] [PDF]

				E. M. Escudero, M. C. C. d. Hurtado, N. G. Perez, and A. L. Tufare Echocardiographic assessment of left ventricular midwall mechanics in spontaneously hypertensive rats Eur J Echocardiogr, June 1, 2004; 5(3): 169 - 175. [Abstract] [Full Text] [PDF]

				J. R. Kizer, D. K. Arnett, J. N. Bella, M. Paranicas, D.C. Rao, M. A. Province, A. Oberman, D. W. Kitzman, P. N. Hopkins, J. E. Liu, et al. Differences in Left Ventricular Structure Between Black and White Hypertensive Adults: The Hypertension Genetic Epidemiology Network Study Hypertension, June 1, 2004; 43(6): 1182 - 1188. [Abstract] [Full Text] [PDF]

				P. Fesler, G. du Cailar, J. Ribstein, and A. Mimran Heterogeneity of Cardiorenal Characteristics in Normotensive Subjects Hypertension, February 1, 2004; 43(2): 219 - 223. [Abstract] [Full Text] [PDF]

				G. de Simone Left Ventricular Geometry and Hypotension in End-Stage Renal Disease: A Mechanical Perspective J. Am. Soc. Nephrol., October 1, 2003; 14(10): 2421 - 2427. [Abstract] [Full Text] [PDF]

				M. Kozakova, E. Ferrannini, and C. Palombo Relation Between Left Ventricular Midwall Function and Coronary Vasodilator Capacity in Arterial Hypertension Hypertension, October 1, 2003; 42(4): 528 - 533. [Abstract] [Full Text] [PDF]

				S. E. Lipshultz, M. J. G. Somers, S. R. Lipsitz, S. D. Colan, K. Jabs, and N. Rifai Serum Cardiac Troponin and Subclinical Cardiac Status in Pediatric Chronic Renal Failure Pediatrics, July 1, 2003; 112(1): 79 - 86. [Abstract] [Full Text] [PDF]

				J. E. Liu, D. C. Robbins, V. Palmieri, J. N. Bella, M. J. Roman, R. Fabsitz, B. V. Howard, T. K. Welty, E. T. Lee, and R. B. Devereux Association of albuminuria with systolic and diastolic left ventricular dysfunction in type 2 diabetes: The Strong Heart Study J. Am. Coll. Cardiol., June 4, 2003; 41(11): 2022 - 2028. [Abstract] [Full Text] [PDF]

				M. Kozakova, G. de Simone, C. Morizzo, and C. Palombo Coronary Vasodilator Capacity and Hypertension-Induced Increase in Left Ventricular Mass Hypertension, February 1, 2003; 41(2): 224 - 229. [Abstract] [Full Text] [PDF]

				G. de Simone, P. Verdecchia, S. Pede, M. Gorini, and A. P. Maggioni Prognosis of Inappropriate Left Ventricular Mass in Hypertension: The MAVI Study Hypertension, October 1, 2002; 40(4): 470 - 476. [Abstract] [Full Text] [PDF]

				W. Tang, D. K. Arnett, R. B. Devereux, M. A. Province, L. D. Atwood, A. Oberman, P. N. Hopkins, and D. W. Kitzman Sibling Resemblance for Left Ventricular Structure, Contractility, and Diastolic Filling Hypertension, September 1, 2002; 40(3): 233 - 238. [Abstract] [Full Text] [PDF]

				K. Wachtell, V. Palmieri, M. H. Olsen, E. Gerdts, V. Papademetriou, M. S. Nieminen, G. Smith, B. Dahlof, G. P. Aurigemma, and R. B. Devereux Change in Systolic Left Ventricular Performance After 3 Years of Antihypertensive Treatment: The Losartan Intervention for Endpoint (LIFE) Study Circulation, July 9, 2002; 106(2): 227 - 232. [Abstract] [Full Text] [PDF]

				A. Ilercil, R. B. Devereux, M. J. Roman, M. Paranicas, M. J. O'Grady, E. T. Lee, T. K. Welty, R. R. Fabsitz, and B. V. Howard Associations of Insulin Levels With Left Ventricular Structure and Function in American Indians : The Strong Heart Study Diabetes, May 1, 2002; 51(5): 1543 - 1547. [Abstract] [Full Text] [PDF]

				E. Gerdts, L. Oikarinen, V. Palmieri, J. E. Otterstad, K. Wachtell, K. Boman, B. Dahlof, and R. B. Devereux Correlates of Left Atrial Size in Hypertensive Patients With Left Ventricular Hypertrophy: The Losartan Intervention For Endpoint Reduction in Hypertension (LIFE) Study Hypertension, March 1, 2002; 39(3): 739 - 743. [Abstract] [Full Text] [PDF]

				V. Palmieri, A. Celentano, M. J. Roman, G. de Simone, M. R. Lewis, L. Best, E. T. Lee, D. C. Robbins, B. V. Howard, and R. B. Devereux Fibrinogen and Preclinical Echocardiographic Target Organ Damage: The Strong Heart Study Hypertension, November 1, 2001; 38(5): 1068 - 1074. [Abstract] [Full Text] [PDF]

				D. K. Arnett, R. B. Devereux, D. Kitzman, A. Oberman, P. Hopkins, L. Atwood, A. Dewan, and D. C. Rao Linkage of Left Ventricular Contractility to Chromosome 11 in Humans: The HyperGEN Study Hypertension, October 1, 2001; 38(4): 767 - 772. [Abstract] [Full Text] [PDF]

				R. B. Devereux, J. N. Bella, V. Palmieri, A. Oberman, D. W. Kitzman, P. N. Hopkins, D.C. Rao, D. Morgan, M. Paranicas, D. Fishman, et al. Left Ventricular Systolic Dysfunction in a Biracial Sample of Hypertensive Adults: The HyperGEN Study Hypertension, September 1, 2001; 38(3): 417 - 423. [Abstract] [Full Text] [PDF]

				J. N. Bella, V. Palmieri, J. E. Liu, D. W. Kitzman, A. Oberman, S. C. Hunt, P. N. Hopkins, D.C. Rao, D. K. Arnett, and R. B. Devereux Relationship Between Left Ventricular Diastolic Relaxation and Systolic Function in Hypertension: The Hypertension Genetic Epidemiology Network (HyperGEN) Study Hypertension, September 1, 2001; 38(3): 424 - 428. [Abstract] [Full Text] [PDF]

				J. E. Liu, V. Palmieri, M. J. Roman, J. N. Bella, R. Fabsitz, B. V. Howard, T. K. Welty, E. T. Lee, and R. B. Devereux The impact of diabetes on left ventricular filling pattern in normotensive and hypertensive adults: the strong heart study J. Am. Coll. Cardiol., June 1, 2001; 37(7): 1943 - 1949. [Abstract] [Full Text] [PDF]

				D. J. Slotwiner, R. B. Devereux, J. E. Schwartz, T. G. Pickering, G. de Simone, and M. J. Roman Relation of Age to Left Ventricular Function and Systemic Hemodynamics in Uncomplicated Mild Hypertension Hypertension, June 1, 2001; 37(6): 1404 - 1409. [Abstract] [Full Text] [PDF]

				G. P. Aurigemma, J. S. Gottdiener, L. Shemanski, J. Gardin, and D. Kitzman Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: The Cardiovascular Health Study J. Am. Coll. Cardiol., March 15, 2001; 37(4): 1042 - 1048. [Abstract] [Full Text] [PDF]

				R. Zeltner, C. Delles, M. Schneider, W. Siffert, and R. E. Schmieder G-Protein {beta}3 Subunit Gene (GNB3) 825T Allele Is Associated With Enhanced Renal Perfusion in Early Hypertension Hypertension, March 1, 2001; 37(3): 882 - 886. [Abstract] [Full Text] [PDF]

				S. Perlini, M. L. Muiesan, C. Cuspidi, L. Sampieri, B. Trimarco, G. P. Aurigemma, E. Agabiti-Rosei, and G. Mancia Midwall Mechanics Are Improved After Regression of Hypertensive Left Ventricular Hypertrophy and Normalization of Chamber Geometry Circulation, February 6, 2001; 103(5): 678 - 683. [Abstract] [Full Text] [PDF]

				V. Palmieri, J. N. Bella, D. K. Arnett, J. E. Liu, A. Oberman, M.-Y. Schuck, D. W. Kitzman, P. N. Hopkins, D. Morgan, D. C. Rao, et al. Effect of Type 2 Diabetes Mellitus on Left Ventricular Geometry and Systolic Function in Hypertensive Subjects : Hypertension Genetic Epidemiology Network (HyperGEN) Study Circulation, January 2, 2001; 103(1): 102 - 107. [Abstract] [Full Text] [PDF]

				G. Pons-Llado, M. Ballester, X. Borras, F. Carreras, I. Carrio, J. Lopez-Contreras, A. Roca-Cusachs, J. Marrugat, and J. Narula Myocardial cell damage in human hypertension J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2198 - 2203. [Abstract] [Full Text] [PDF]

				J. Mayet, B. Ariff, B. Wasan, N. Chapman, M. Shahi, N. R. Poulter, P. S. Sever, R. A. Foale, and S. A. McG. Thom Improvement in Midwall Myocardial Shortening With Regression of Left Ventricular Hypertrophy Hypertension, November 1, 2000; 36(5): 755 - 759. [Abstract] [Full Text] [PDF]

				M. Kozakova, F. Galetta, L. Gregorini, G. Bigalli, F. Franzoni, C. Giusti, and C. Palombo Coronary Vasodilator Capacity and Epicardial Vessel Remodeling in Physiological and Hypertensive Hypertrophy Hypertension, September 1, 2000; 36(3): 343 - 349. [Abstract] [Full Text] [PDF]

				R. B. Devereux, M. J. Roman, M. Paranicas, M. J. O'Grady, E. T. Lee, T. K. Welty, R. R. Fabsitz, D. Robbins, E. R. Rhoades, and B. V. Howard Impact of Diabetes on Cardiac Structure and Function : The Strong Heart Study Circulation, May 16, 2000; 101(19): 2271 - 2276. [Abstract] [Full Text] [PDF]

				M. A. Quinones, B. H. Greenberg, H. A. Kopelen, C. Koilpillai, M. C. Limacher, D. M. Shindler, B. J. Shelton, D. H. Weiner, and for the SOLVD Investigators Echocardiographic predictors of clinical outcome in patients with left ventricular dysfunction enrolled in the SOLVD registry and trials: significance of left ventricular hypertrophy J. Am. Coll. Cardiol., April 1, 2000; 35(5): 1237 - 1244. [Abstract] [Full Text] [PDF]

				J. E. Liu, R. T. Hahn, K. M. Stein, S. M. Markowitz, P. M. Okin, R. B. Devereux, and B. B. Lerman Left Ventricular Geometry and Function Preceding Neurally Mediated Syncope Circulation, February 22, 2000; 101(7): 777 - 783. [Abstract] [Full Text] [PDF]

				J. Muller, G. Wallukat, M. Dandel, H. Bieda, K. Brandes, S. Spiegelsberger, E. Nissen, R. Kunze, and R. Hetzer Immunoglobulin Adsorption in Patients With Idiopathic Dilated Cardiomyopathy Circulation, February 1, 2000; 101(4): 385 - 391. [Abstract] [Full Text] [PDF]

				G. de Simone, R. Greco, G. Mureddu, C. Romano, R. Guida, A. Celentano, and F. Contaldo Relation of Left Ventricular Diastolic Properties to Systolic Function in Arterial Hypertension Circulation, January 18, 2000; 101(2): 152 - 157. [Abstract] [Full Text] [PDF]

				V. Palmieri, B. Dahlof, V. DeQuattro, N. Sharpe, J. N. Bella, G. de Simone, M. Paranicas, D. Fishman, and R. B. Devereux Reliability of echocardiographic assessment of left ventricular structure and function: The PRESERVE study J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1625 - 1632. [Abstract] [Full Text] [PDF]