title: Importance of dynamic dyssynchrony in the occurrence of hypertensive heart failure with normal ejection fraction.
abstract: OBJECTIVE
  The impact of haemodynamic stress on left ventricular (LV) dyssynchrony in heart failure with normal ejection fraction (HFNEF) remains unknown. We sought to evaluate the relationship and predictive value of dynamic changes of LV dyssynchrony on hypertensive HFNEF.
  
  
  RESULTS
  A total of 131 subjects including 47 hypertensive HFNEF patients, 34 hypertensive patients with left ventricular hypertrophy (LVH) without HFNEF, and 50 normal controls were studied by dobutamine stress echocardiography with tissue Doppler imaging. Systolic and diastolic dyssynchrony were assessed using the LV six-basal-six-mid-segment model and cut-off values were derived from normal controls. The mean basal segments longitudinal systolic (mean Sm) and early diastolic (mean Em) velocities were measured. In normal controls, systolic and diastolic dyssynchrony did not develop during stress. The prevalence of resting systolic (36.2% vs. 38.2%, P = 0.85) and diastolic (34.0% vs. 29.4%, P = 0.66) dyssynchrony was similar in HFNEF and LVH groups. During stress, the prevalence of systolic and diastolic dyssynchrony increased dramatically to 85.1% and 87.2%, respectively, in HFNEF group, but only 52.9% and 58.8% in LVH group (P < 0.005). In HFNEF group, stress-induced increase in mean Sm was significantly blunted (2.8 ± 2.0 vs. 4.2 ± 2.4 cm/s, P = 0.004), and the increase was abolished for mean Em (-0.3 ± 2.5 vs. 2.4 ± 3.4 cm/s, P < 0.001). On multivariate analysis, stress-induced changes in mean Em (OR = 0.69, P = 0.004) and mean Sm (OR = 0.56, P = 0.004), and diastolic (OR = 4.6, P = 0.005) and systolic dyssynchrony during stress (OR = 4.3, P = 0.038) were independent determinants for occurrence of HFNEF.
  
  
  CONCLUSIONS
  Dynamic dyssynchrony during stress and impaired myocardial longitudinal function reserve are characteristics of HFNEF.
authors.affiliation: Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China.
authors.forename: Alex Pui-Wai
authors.initials: AP
authors.lastname: Lee
authors.forename: Jae-Kwan
authors.initials: JK
authors.lastname: Song
authors.forename: Gabriel Wai-Kwok
authors.initials: GW
authors.lastname: Yip
authors.forename: Qing
authors.initials: Q
authors.lastname: Zhang
authors.forename: Tian-Gang
authors.initials: TG
authors.lastname: Zhu
authors.forename: Chunmei
authors.initials: C
authors.lastname: Li
authors.forename: Anna
authors.initials: A
authors.lastname: Chan
authors.forename: Cheuk-Man
authors.initials: CM
authors.lastname: Yu
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006333:Heart Failure / Q000209:etiology* / Q000503:physiopathology; D006439:Hemodynamics; D006801:Humans; D006973:Hypertension / Q000209:etiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D013318:Stroke Volume / Q000502:physiology; D018487:Ventricular Dysfunction, Left / Q000150:complications* / Q000503:physiopathology