Abstract 2839: Abnormalities of Myocardial Systolic Function are related to Cardiac Structural Changes in Patients with Hypertension and Diastolic Dysfunction: The VALIDD Study
Background: Patients with hypertension (HTN) have higher risk of developing left ventricular hypertrophy (LVH), myocardial fibrosis, and chronic heart failure (HF). Given the prevalence of HTN and its strong association with HF, identification of early, subclinical abnormalities might be useful in designing preventive strategies. We hypothesized that abnormalities in systolic strain rate (SRs) might represent such an abnormality.
Methods: 384 patients with hypertension, normal ejection fraction and diastolic dysfunction were enrolled in the VALsartan in Diastolic Dysfunction (VALIDD) trial. We computed peak longitudinal systolic strain rate (SRs) using speckle tracking (Velocity Vector Imaging, Siemens, Inc.) in 366 patients. We related this measure of systolic function to diastolic function parameters, blood pressure, and measures of LV/LA structure/remodeling.
Results The baseline ejection fraction in VALIDD ranged from 49.2 to 64.4% (mean 56.9 ± 3.1%), and SRs ranged from −1.04 to −0.55 (mean −0.74 ± 0.10 1/s). Worse systolic function, assessed by SRs, was associated with reduced myocardial relaxation velocity E’ (r=−0.28, p<0.001), prolonged isovolumic relaxation time (r=0.21, p<0.001), increased LV mass index (r=0.31, p<0.001), increased relative wall thickness (r=0.32, p<0.001) and increased LA volume index (r=0.12, p=0.02). Both decreased SRs and E’ were related to elevations in systolic blood pressure (Table 1⇓).
Conclusion Systolic strain rate, a descriptor of systolic function, tracks with variables of LV geometry and diastolic function in hypertensives with normal ejection fraction. These data suggest that abnormalities of systolic function, diastolic function and cardiac structure may progress in parallel, and that SRs is influenced by load.