Hypertensive Heart Disease
Figure 4: Prevalence of Left Ventricular Chamber and Myocardial Dysfunction According to Left Ventricular Geometrical Patterns
45 A p
33.5 34
33 0 EFS
Concentric remodelling Concentric hypertrophy
EFS = endocardial fractional shortening; MWS = midwall shortening. Source: Wachtell et al., 2001.57
relationship between depressed systolic midwall mechanics and abnormal diastolic LV filling in patients with high LV mass.62,63
Changes in Left Ventricular Systolic Function During Antihypertensive Treatment Systematic antihypertensive treatment can substantially change systolic performance. Lowering blood pressure by 27/13mmHg in the LIFE echocardiography study resulted in a slight reduction in endocardial FS, while MWS increased from 15.4 to 16.8% and stress- corrected MWS, a measure of myocardial contractility, increased from 97 to 105%. In addition, Wachtell et al. found that patients with or without LV mass regression had a mild reduction of endocardial FS during antihypertensive treatment. However, only patients with LV mass decrease had significant improvement in MWS and stress- corrected MWS (see Figure 5). Finally, multivariate analyses confirmed that these improvements were related to changes in LV mass, relative wall thickness and stroke volume.64
These findings indicate that partial
normalisation of blood pressure and LV mass can result in reversal of both supranormal LV chamber function and the low function of average myocardial fibres at the LV midwall that is often impaired in hypertensive heart disease. Furthermore, Gerdts et al. reported that hypertensive women in the LIFE echocardiography study retained higher LV ejection fraction and stress-corrected MWS compared with men, despite less hypertrophy regression during long-term antihypertensive treatment.65
The clinical significance of this is that LV
systolic function can be improved by systematic antihypertensive treatment even in patients with preserved LV ejection fraction.
Prognostic Significance of Treating Systolic Function in Left Ventricular Hypertrophy and Preserved Left Ventricular Systolic Function In a study of 294 hypertensive patients receiving varying treatment, de Simone et al.66
showed that depressed MWS predicted adverse
outcomes, especially in the subgroup with LV hypertrophy, whereas endocardial FS did not. This was subsequently confirmed in other observational studies.67,68
Data from the LIFE echocardiographic study
further expanded knowledge of treatment effects on LV systolic function. Analysis in hypertensive patients with preserved ejection
EUROPEAN CARDIOLOGY
fraction showed that higher in-treatment endocardial FS was associated with 35% fewer subsequent fatal and non-fatal myocardial
27 Source: Wachtell et al., 2002.64
32.5 32
31.5 31
LV mass decrease (n=597)
Baseline B p
16.5 17
15.5 16
15 14.5
LV mass decrease (n=597)
Baseline C p
100 102 104 106
98 96
94 92
LV mass decrease (n=597)
Baseline
No LV mass decrease (n=82)
36 months p
No LV mass decrease (n=82)
36 months p
No LV mass decrease (n=82)
36 months p
Figure 5: Effect of Left Ventricular Hypertrophy Regression on Endocardial Fractional Shortening (A), Midwall Shortening (B) and Stress-corrected Midwall Shortening (C)
Percentage
Percentage
Percentage
Percentage
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