Left ventricular mass and systolic dysfunction in essential hypertension.
A relation between left ventricular (LV) hypertrophy and depressed midwall systolic function has been described in hypertensive subjects. However, a strong confounding factor in this relation is concentric geometry, which is both a powerful determinant of depressed midwall systolic function and a correlate of LV mass in hypertension. To evaluate the independent contribution of LV mass to depressed systolic function, 1827 patients with never-treated essential hypertension (age 48 +/- 12 years, men 58%) underwent M-mode echocardiography under two-dimensional guidance. Relative wall thickness was the strongest determinant of low midwall fractional shortening (r = -0.63, P < 0.0001). The significant inverse relation observed between LV mass and midwall fractional shortening (r = -0.43, P < 0.0001) persisted after taking into account the effect of relative wall thickness (partial r = -0.27, P < 0.0001). Within each sex-specific quintile of relative wall thickness, prevalence of subnormal afterload-corrected midwall systolic function was greater in subjects with, than in subjects without, LV hypertrophy (P < 0.05 for the first, third, fourth and fifth quintile). In a multiple linear regression analysis, both LV mass (P < 0.0001) and relative wall thickness (P < 0.0001) were independent predictors of a reduced midwall fractional shortening. In conclusion, the inverse association between LV mass and midwall systolic function is partly independent from the effect of relative wall thickness. LV hypertrophy is a determinant of subclinical LV dysfunction independently of the concomitant changes in chamber geometry.
Schillaci
G
G
Unit of Internal Medicine, Angiology and Arteriosclerosis, University of Perugia, Italy. skill@unipg.it
Vaudo
G
G
Pasqualini
L
L
Reboldi
G
G
Porcellati
C
C
Verdecchia
P
P
D000328:Adult; D017677:Age Distribution; D000368:Aged; D001795:Blood Pressure Determination; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D016001:Confidence Intervals; D015986:Confounding Factors, Epidemiologic; D004452:Echocardiography; D005260:Female; D006334:Heart Function Tests; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012016:Reference Values; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D013599:Systole / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000453:epidemiology*