Effect of geometric remodeling on left ventricular longitudinal contractile reserve in patients with hypertension.
Left ventricular hypertrophy (LVH) is associated with a reduction of subendocardial coronary flow reserve, which may be associated with abnormal myocardial longitudinal function during exercise. To test this hypothesis, 182 hypertensive patients underwent multistage supine bicycle exercise testing. Patients were classified as follows: patients with normal geometry (group 1, n = 116), concentric remodeling (group 2, n = 31), or LVH (group 3, n = 31). The results showed that the ratio of E/E', an index of left ventricular (LV) filling pressure, was significantly elevated in the LVH group at rest and during exercise. At rest, the mitral annular systolic velocity (S') was similar between the three groups at rest, whereas S' during exercise was significantly lower in the LVH group. The magnitude of change in S' during exercise was also significantly lower in the LVH group. Multiple linear regression analysis showed that peak double product (beta = 0.208, P = .006) and LV mass index (beta = -0.158, P = .028) were independently associated with LV longitudinal contractile reserve. Also, multiple linear regression analysis showed that changes in S' from baseline to peak were independently associated with exercise duration (beta = 0.123, P = .041) when controlled for age, male gender, baseline E', peak systolic blood pressure, and LV mass index. The results from this study demonstrate that LVH was significantly associated with abnormal LV longitudinal contractile reserve in hypertensive patients.
Cardiology Division, Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
Sungha
S
Park
Hye-Sun
HS
Seo
Chi Young
CY
Shim
Eui Young
EY
Choi
Young-Guk
YG
Ko
Donghoon
D
Choi
Jong-Won
JW
Ha
Se-Joong
SJ
Rim
Namsik
N
Chung
D003326:Coronary Circulation; D005080:Exercise Test; D005260:Female; D053805:Fractional Flow Reserve, Myocardial; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology*; D020257:Ventricular Remodeling