Endocardial versus midwall measurement of left ventricular function in mild hypertension: an insight from the Harvest Study
| Autor: | Marco Michieletto, Paolo Mormino, Gianluigi Nicolosi, P Visentin, Achille C. Pessina, Paolo Palatini, G. R. Graniero, Paolo Stritoni, Vincenzo Mione |
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| Předmět: |
Adult
Male medicine.medical_specialty Adolescent Physiology Ventricular Function Left Contractility Internal medicine Internal Medicine medicine Humans Left ventricular geometry Left Ventricular Fractional Shortening Endocardium Body surface area Ventricular function business.industry Middle Aged Myocardial Contraction Blood pressure Hypertension Ambulatory Cardiology Regression Analysis Female Hypertrophy Left Ventricular Cardiology and Cardiovascular Medicine business |
| Zdroj: | Europe PubMed Central Web of Science |
| Popis: | Objective To compare endocardial and midwall measurement of left ventricular fractional shortening in assessing cardiac systolic function in hypertension. Setting Seventeen hypertension clinics in northeast Italy. Main outcome measures Left ventricular endocardial fractional shorteningcircumferential stress relationship versus midwall shortening-stress relationship in the subjects divided according to relative wall thickness (RWT) and left ventricular mass indexed by body surface area. Patients Borderline-to-mild hypertensives [n = 635, aged 33±0.3 years (mean±SEM), office blood pressure 146 ± 0.4/94 ± 0.2 mmHg (means ± SEM)] in the Harvest Study and 50 normotensive controls with similar age and sex distributions. Methods Blood pressure was measured by 24h ambulatory monitoring. Left ventricular dimensional and functional indices were assessed by M-mode echocardiography. Results In the subjects divided into quintiles of RWT, the left ventricular shortening-stress relationship was increased in a parallel fashion when calculated by endocardial and by midwall measurements for RWT ≤ 0.35. Instead, for greater RWT values (> 0.37) endocardial measurement constantly gave larger values than did midwall measurement. Both the endocardial and the midwall shortening-stress relationships progressively decreased with increasing RWT. However, the endocardial shortening-stress relationship remained greater than normal at any RWT, whereas the midwall shortening-stress relationship was decreased for RWT ≥ 0.37. In a multiple-regression analysis RWT was the most potent predictor of the endocardialmidwall shortening difference, left ventricular mass and 24h systolic blood pressure being the second and third most potent predictors. Conclusions We found a parallel increase in indices of cavity emptying and of myocardial contractility in mild hypertensive subjects with normal left ventricular geometry. When the RWT is increased, ejection phase indices may be normal in the presence of decreased myocardial contractility. |
| Databáze: | OpenAIRE |
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