Abstract 18261: Left Ventricular Longitudinal Myocardial Workload is More Severely Reduced in Hypertensive Patients with Concentric Hypertrophy Than in Those with Eccentric Hypertrophy
Background: In patients with hypertensive heart disease (HHD), left ventricular (LV) longitudinal myocardial shortening is reduced even if ejection fraction (EF) is preserved. However, it remains to be elucidated whether the intrinsic myocardial dysfunction depends on LV geometry or not. Thus LV myocardial workload was calculated from meridional wall stress (MWS) and speckle tracking echocardiography (STE)-derived longitudinal strain (LS), and compared between patients with concentric hypertrophy (CH) and those with eccentric hypertrophy (EH).
Methods: STE was performed in 46 HHD patients with normal EF (>50%), consisting of 32 patients with CH and 14 EH, and 29 age-matched control subjects, by using a Toshiba Artida system. Peak value of global LS was measured in the apical 4-chamber view. LV end-systolic MWS was measured, and stress-strain product [SSP: MWSх(-LS)] was calculated as an index of LV longitudinal myocardial workload per unit cross-sectional area.
Results: LV dimension was smaller (46.9±3.3 vs 50.4±4.0 mm, p<0.01) and interventricular septal thickness was greater (13.0±1.7 vs 11.4±1.2 mm, p<0.01) in CH than EH, whereas systolic blood pressure (147±19 vs 147±23 mm Hg, p=0.98) and LV mass index (129±21 vs 121±18 g•m-2, p=0.14) were comparable between groups. As a result, MWS was lower in CH than EH (490±137 vs 589±130 dyn•mm-2, p<0.05). LS was lower in both CH (-12.9±3.2%, p<0.001) and EH (-14.7±2.8%, p<0.05) than in controls (-16.9±3.0%), but not significantly different between CH and EH (p=0.069). However, SSP was lower in CH than EH (63±23 vs 87±29 dyn•mm-2, p<0.05), both of which were significantly lower than controls (108±36 dyn•mm-2; p<0.001 and p<0.05, respectively).
Conclusions: LV longitudinal myocardial workload per unit cross-sectional area was lower in HHD patients with CH than in those with EH, suggesting that intrinsic longitudinal myocardial shortening is more severely impaired in those with CH than EH.
Author Disclosures: S. Yamada: None. K. Okada: None. H. Nishino: None. H. Iwano: None. D. Murai: None. T. Hayashi: None. M. Nakabachi: None. A. Ichikawa: None. S. Yokoyama: None. S. Kaga: None. T. Mikami: None. H. Tsutsui: Research Grant; Significant; MSD, Astellas, Ohtsuka, Shionogi, Daiichi-sankyo, Tanabe-Mitsubishi, Novartis, Pfizer. Honoraria; Significant; Daiichi-Sankyo, Tanabe-Mitsubishi, Pfizer, MSD.
- © 2014 by American Heart Association, Inc.