title: Is it only diastolic dysfunction? Segmental relaxation patterns and longitudinal systolic deformation in systemic hypertension.
abstract: OBJECTIVE
  To investigate changes in longitudinal systolic function estimated by strain echocardiography in relation to global diastolic dysfunction and alterations in segmental relaxation patterns.
  
  
  RESULTS
  We studied 75 hypertensive patients, of whom 45 had diastolic dysfunction and normal EF, and 30 matched controls. All subjects had 2D and colour Doppler myocardial imaging. Mean longitudinal strain (S) and strain rate (SR) were averaged from the basal and mid-LV segments assessed in the longitudinal axis. Early to late diastolic SR ratio <1.1 was defined as altered segmental relaxation [segmental diastolic dysfunction (DD)]. The total number of segmental DD out of the 18 basal-mid-apical segments was calculated for all the participants. Longitudinal systolic function estimated by mean strain and SR was decreased in the hypertensive group, but was further deteriorated in the diastolic dysfunction group compared with controls. Altered Segmental Relaxation was highly correlated with longitudinal systolic dysfunction expressed by strain (r: -0.56)or SR (r: -0.57). A septal mitral annular Ea cut-off of 5.9 cm/s predicted longitudinal systolic dysfunction with a sensitivity of 81% and a specificity of 70%. A multiple linear regression model proved LVMI, systolic blood pressure (SBP) and age as independent predictors of diastolic and longitudinal systolic dysfunction and BMI to independently related to diastolic dysfunction.
  
  
  CONCLUSIONS
  Longitudinal systolic dysfunction may be present in hypertensive patients with diastolic dysfunction, especially when septal Ea < 5.9 cm/s. Altered segmental relaxation pattern is highly correlated with longitudinal systolic dysfunction. LV hypertrophy, SBP and aging are important determinants of both diastolic and longitudinal systolic dysfunction, whereas obesity appears to contribute to the appearance of diastolic dysfunction.
authors.affiliation: Echocardiography Department, Imperial College of Medicine and Technology, National Heart and Lung Institute (NHLI), Hammersmith Hospital, Du Cane Road, W12 0HS London, UK. drpavlo@yahoo.com
authors.forename: Harry
authors.initials: H
authors.lastname: Pavlopoulos
authors.forename: Julia
authors.initials: J
authors.lastname: Grapsa
authors.forename: Ellie
authors.initials: E
authors.lastname: Stefanadi
authors.forename: Elena
authors.initials: E
authors.lastname: Philippou
authors.forename: David
authors.initials: D
authors.lastname: Dawson
authors.forename: Petros
authors.initials: P
authors.lastname: Nihoyannopoulos
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003971:Diastole; D004452:Echocardiography / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*; D007091:Image Processing, Computer-Assisted; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology*