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.

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				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]

				G. K. Kapuku, F. A. Treiber, H. C. Davis, G. A. Harshfield, B. B. Cook, and G. A. Mensah Hemodynamic Function at Rest, During Acute Stress, and in the Field : Predictors of Cardiac Structure and Function 2 Years Later in Youth Hypertension, November 1, 1999; 34(5): 1026 - 1031. [Abstract] [Full Text] [PDF]

				V. Palmieri, G. de Simone, M. J. Roman, J. E. Schwartz, T. G. Pickering, and R. B. Devereux Ambulatory Blood Pressure and M;etabolic Abnormalities in Hypertensive Subjects With Inappropriately High Left Ventricular Mass Hypertension, November 1, 1999; 34(5): 1032 - 1040. [Abstract] [Full Text] [PDF]

				M. G. Modena, N. Muia Jr, P. Aveta, R. Molinari, and R. Rossi Effects of Transdermal 17{beta}-Estradiol on Left Ventricular Anatomy and Performance in Hypertensive Women Hypertension, November 1, 1999; 34(5): 1041 - 1046. [Abstract] [Full Text] [PDF]

				J. N. Bella, M. J. Roman, R. Pini, J. E. Schwartz, T. G. Pickering, and R. B. Devereux Assessment of Arterial Compliance by Carotid Midwall Strain-Stress Relation in Normotensive Adults Hypertension, March 1, 1999; 33(3): 787 - 792. [Abstract] [Full Text] [PDF]

				G. de Simone, M. J. Roman, M. J. Koren, G. A. Mensah, A. Ganau, and R. B. Devereux Stroke Volume/Pulse Pressure Ratio and Cardiovascular Risk in Arterial Hypertension Hypertension, March 1, 1999; 33(3): 800 - 805. [Abstract] [Full Text] [PDF]

				V. Di Bello, R. Pedrinelli, D. Giorgi, A. Bertini, M. Bianchi, M. Paterni, M. F. Romano, G. Dell'Omo, and C. Giusti Ultrasonic Myocardial Texture Versus Doppler Analysis in Hypertensive Heart : A Preliminary Study Hypertension, January 1, 1999; 33(1): 66 - 73. [Abstract] [Full Text] [PDF]

				G. Schillaci, P. Verdecchia, C. Borgioni, A. Ciucci, and C. Porcellati Early Cardiac Changes After Menopause Hypertension, October 1, 1998; 32(4): 764 - 769. [Abstract] [Full Text] [PDF]

				G. de Simone, R. B. Devereux, T. R. Kimball, G. F. Mureddu, M. J. Roman, F. Contaldo, and S. R. Daniels Interaction Between Body Size and Cardiac Workload : Influence on Left Ventricular Mass During Body Growth and Adulthood Hypertension, May 1, 1998; 31(5): 1077 - 1082. [Abstract] [Full Text] [PDF]

				R. B. Devereux, G. de Simone, T. G. Pickering, J. E. Schwartz, and M. J. Roman Relation of Left Ventricular Midwall Function to Cardiovascular Risk Factors and Arterial Structure and Function Hypertension, April 1, 1998; 31(4): 929 - 936. [Abstract] [Full Text] [PDF]

				D. B. Sadler, G. P. Aurigemma, D. W. Williams, D. J. Reda, B. J. Materson, and J. S. Gottdiener Systolic Function in Hypertensive Men With Concentric Remodeling Hypertension, October 1, 1997; 30(4): 777 - 781. [Abstract] [Full Text]

				R. B. Devereux, M. J. Roman, G. de Simone, M. J. O'Grady, M. Paranicas, J. Yeh, R. R. Fabsitz, and B. V. Howard Relations of Left Ventricular Mass to Demographic and Hemodynamic Variables in American Indians : The Strong Heart Study Circulation, September 2, 1997; 96(5): 1416 - 1423. [Abstract] [Full Text]

				G. de Simone, G. F. Mureddu, R. Greco, L. Scalfi, A. Esposito Del Puente, A. Franzese, F. Contaldo, and R. B. Devereux Relations of Left Ventricular Geometry and Function to Body Composition in Children With High Casual Blood Pressure Hypertension, September 1, 1997; 30(3): 377 - 382. [Abstract] [Full Text]

				G. de Simone Mary J. Roman Stephen R. Daniels GianFra Age-Related Changes in Total Arterial Capacitance From Birth to Maturity in a Normotensive Population Hypertension, June 1, 1997; 29(6): 1213 - 1217. [Abstract] [Full Text]