高血压左室构型与左室中层力学的关系

目的：用室壁应力－左室中层缩短率关系做为评价心肌收缩性的指标,研究高血压不同左室构患者心肌收缩性的改变与心功能变化的关系。方法：应用超声心动图计算左室重量指数（ＬＶＭＩ）和相对室壁厚度（ＲＷＴ）,按ＬＶＭＩ和ＲＷＴ将左心室分为四种构型。对１１７例原发性高血压病人和４５例健康人左心室结构按左室室壁应力（ＭＥＳＳ）和室壁中层缩短率（ｍＦＳ）来估计心功能情况。结果：以射血分数、左室短轴缩短率和左室中层缩短率表示的收缩功能离心性肥厚受损严重,以室壁应力－左室中层缩短率关系表示的心肌收缩性,向心性肥厚最重。以ＥＦ斜率等表示的心脏舒张功能高血压不同左室构型患者损害不同,舒张功能的改变与心肌收缩必的损害成正相关。结论：高血压不同左室构型患者心肌收缩性损害不同,左室构型向向心性发展在一定阶段上代偿了心肌收缩性的下降,以保持心脏     

Variations in cardiac diastolic function in hypertensive patients with different left ventricular geometric patterns.

To evaluate the alteration of cardiac function in hypertensive patients with different left ventricular geometric patterns. Echocardiography was used to study left ventricular geometry and cardiac diastolic function in 117 cases of essential hypertension, with 45 normal cases as controls. Echocardiographic date were used to calculated the left ventricular mass index (LVMI) and relative wall thickness (RWT), which values in turn were used to divide the subjects into four groups. The left atrial dimension of the group, with the exception of these hypertensives who showed normal geometry, was larger than that of the control group. The damage of peak of E velocity, peak of A velocity, E/A and the slope between the E and F points (E to F slope) were greater than in hypertension than in the control group. The concentric hypertrophy group and eccentric hypertrophy group suffered more serious damage of left ventricular diastolic function than the concentric remodeling group, and damage of left ventricular diastolic function in the concentric remodeling group was greater than that in the normal geometry group. The degree of cardiac diastolic function damage differed among patients with different left ventricular geometric patterns, when the cardiac structure was changed, the degree of cardiac diastolic function damage increased.     

脑钠肽与高血压左室重塑、左室功能的关系

目的:探讨原发性高血压(EH)患者脑钠肽(BNP)水平与左室几何构型、左室功能的关系。方法:应用荧光免疫法快速测定EH组(106例)和对照组(46例)的血浆BNP浓度,根据心脏彩色超声检测结果,依照左室重量指数(LVMI)、相对室壁厚度(RWT)将106例EH患者分为:正常构型亚组(12例)、向心性重构亚组(9例)、离心性肥厚亚组(64例)、向心性肥厚亚组(21例)。应用相关性分析了解EH组LVMI、RWT、年龄、血压、体质指数(BMI)、左室射血分数(LVEF)等因素与BNP关系。结果:在EH各构型亚组中LVMI以离心性肥厚亚组最高,向心性肥厚亚组、离心性肥厚亚组BNP水平较对照组升高明显。EH组LVMI与BNP具有明显的正相关性(r=0.605,P<0.01),RWT与BNP具有明显的负相关(r=-0.266,P<0.01),LVEF与BNP呈负相关(r=-0.552,P<0.01),LVMI、RWT与血压、BMI之间无明显相关性。结论:EH组中不同的左室几何构型对BNP水平产生不同影响,具有更高的LVMI值和更低的LVEF、RWT值患者,BNP水平更高,而年龄、血压、BMI与BNP、LVMI、RWT无明显相关性。     

Angiotensin-converting enzyme gene polymorphism and geometric patterns of hypertensive left ventricular hypertrophy

Polymorphism in the angiotensin-converting enzyme (ACE) gene has been found to be associated with left ventricular hypertrophy (LVH) in patients with essential hypertension (EHT) in certain populations. We sought to evaluate, in a Japanese population, whether ACE genotype is related to left ventricular mass, or to the geometry of LVH in EHT. Eighty-seven patients with EHT were examined. Their relative wall thickness (RWT) and left ventricular mass index (LVMI), determined by echocardiogram, were used to divide them into 4 groups: normal (normal RWT and LVMI, n = 35); concentric remodeling (increased RWT but normal LVMI, n= 10); eccentric hypertrophy (increased LVMI but normal RWT, n = 20); and concentric hypertrophy (increased LVMI and RWT, n = 22). Genetic analysis for ACE genotypes was performed on peripheral leukocytes using PCR techniques. Interventricular septal thickness and RWT were significantly greater in the patients with the DD genotype than in those with the II genotype, but LVMI did not differ among the three ACE genotypes. The frequency of the DD genotype was higher in the concentric hypertrophy group than in each of the other groups, and the frequency of the II genotype was lower in the concentric hypertrophy group than in either the normal or eccentric hypertrophy group. The geometric pattern of hypertensive LVH was associated with ACE genotype in a Japanese population. The DD genotype may contribute to concentric hypertrophy, but not to eccentric hypertrophy.     

左心室功能、质量及几何构型对高血压患者自主神经功能的影响

目的 探讨高血压患者不同左心室功能、质量、几何构型心率变异性(HRV)指标的差别及对自主神经调节的影响。方法将300例高血压患者分别分为收缩功能不全与正常组;舒张功能异常与正常组;左心室肥厚(LVH)与正常组及几何构型正常和异常组,后者包括向心性重构、离心性肥厚和向心性肥厚三个亚组,分别比较各对应组间HRV指标的差别,并对左心室射血分数(LVEF)、二尖瓣血流频谱E峰、A峰比值(E/A)、左心室质量指数(LVMI)、相对室壁厚度(RWT)与HRV各指标间的相关性进行了分析。结果 左心室收缩功能不全组与正常组间HRV各项指标无显著性差异,舒张功能异常组HRV各项指标均显著低于正常组,LVH组部分指标[正常窦性心搏间期的标准差(SDNN)、5min连续时间段标准差的平均值(SDNNI)、低频功率(LF)和高频功率(HF)]明显低于正常组,除相邻正常窦性心搏间期(NN)间期差的均方根(rMMSD)和NN间期差大于50ms心搏与总NN间期的百分比(PNN50)外,3个几何构型异常组HRV各项指标均明显低于正常组,但各异常组间无显著性差异。单变量回归分析提示RWT、LVMI、LVEF与HRV主要指标存在显著的相关性,E/A与HRV各项指标均显著相关。多变量分析提示RWT与SDNN、LVMI与SDANN、LVEF与SDNN、E/A与LF独立相关。结论 左心室功能损害、LVH及几何构型异常可影     

高血压病患者左心室几何构型与舒张功能变化的关系

目的　研究高血压病患者左心室重构与舒张功能变化的关系及影响因素。方法　依照左心室质量指数 (L V-MI)和相对室壁厚度 (RWT)将 89例无合并症的高血压病患者分为左心室正常构型组 (17例 )、向心性重构组 (2 3例 )、向心性肥厚组 (33例 )、离心性肥厚组 (16例 )。对超声心动图心脏结构和功能测值进行多元逐步回归分析 ,筛选出对左心室舒张功能有独立影响因素。在校正这些因素影响后 ,比较不同左心室几何构型组间心脏舒张功能的差异 ,82例正常人作为对照。结果　左心室舒张功能的主要独立影响因素包括性别、年龄、心率、L VMI,部分指标还有体重指数 (BMl)和吸烟水平。不同构型组间舒张功能指标未经校正或仅经性别、年龄、心率和 BMI校正后差异虽都具有高度显著性 (P<0 .0 5 ) ,但再校正或排外血压水平的影响后 ,组间差异显著性已不复存在。结论　不同构型组间左心室舒张功能指标的差异主要是血压水平不同所致。左心室结构指标虽是舒张功能指标的独立影响因素 ,但其影响强度尚不足以达到使不同构型组间差异有统计学显著性的程度。     

原发性高血压患者血清胱抑素C与左室构型的关系

目的 研究心功能正常范围原发性高血压患者血清胱抑素C（CysC）水平与左室构型变化的关系,探讨左室重构与CysC的相关性,并探讨其机制.方法 纳入收缩功能正常（LVEF＞50％）原发性高血压患者180例为试验组,正常体检者50名为对照组.检测血清CysC浓度并行超声心动图检查,测量左室舒张末期内径（LVDD）、室间隔厚度（ⅣS）、左室后壁厚度（LVPW）,并计算左室重量指数（LVMI）、室壁相对厚度（RWT）.按Ganau’s分类法,将试验组分为正常型、向心性重构型、向心性肥厚型、离心性肥厚型4种构型,对各组间血浆CysC水平进行两两比较.结果 试验组较对照组血清CyaC浓度明显升高（P＜0.05）.按Ganau’s分类后,以向心性肥厚组CysC水平升高最显著（P＜0.05）,向心性构型组和离心性肥厚组依次次之（P＜0.05,P＜0.05）,正常构型组CysC水平升高最低.正常构型组较对照组CysC水平升高,但差异无统计学意义（P＞0.05）.结论 原发性高血压患者血清CysC浓度与左室构型相关,CysC在原发性高血压左室构型的变化发展中起着一定作用.     

Relation between left ventricular geometric alteration and extracardiac target organ damage in hypertensive patients.

To study the relation between left ventricular geometric alteration and extracardiac target organ damage in hypertensive patients. A retrospective study of 298 patients with essential hypertension was performed. Left ventricular mass index (LVMI) and relative wall thickness (RWT) were calculated using echocardiographic data. Patients were divided into four groups based on their left ventricular geometric pattern as determined using LVMI and RWT. Each of the four left ventricular geometric patterns was associated with a different degree of extracardiac organ damage. In multivariate analysis, LVMI and RWT showed strong, significant correlation to retinal changes and increases in serum creatinine levels, respectively. Alteration of left ventricular geometry resulted in an increase in the degree of extracardiac target organ damage. Echocardiographic classification of left ventricular geometry can further stratify hypertensive patients according to risk, and possibly according to the indications for intensive treatment.     

心率变异性与高血压左室重构关系的研究

目的：心率变异性（ＨＲＶ）分析是反映心脏自主神经活动的一项无创性指标。方法：研究ＨＲＶ在高血压左室重构中的作用,应用ＨＲＶ时域与频域分析法,检测与分析７０例高血压病（ＥＨ）男性患者２４小时ＲＲ间期标准差（ＳＤＮＮ）、心率变异指数（ＨＲＶＩ）及心率功率谱密度（ＰＳＤ）;并采用超声心动图测定相对室壁厚度（ＲＷＴ）与左室重量指数（ＬＶＭＩ）对患者进行左室构型分类。３０例健康男性被同期检测,以作对照。结果：７０ 例ＥＨ 患者被分为正常构型（ＲＷＴ 与ＬＶＭＩ均正常）,向心性重构（ＲＷＴ 增加,但ＬＶＭＩ正常）,向心性肥厚（ＲＷＴ与ＬＶＭＩ均增加）及离心性肥厚（ＲＷＴ正常,但ＬＶＭＩ增加）四个左室构型组。四组患者ＳＤＮＮ、ＨＲＶＩ、ＰＳＤ的低频（ＬＦ）峰值及其与高频（ＨＦ）峰值之比（ＬＦ／ＨＦ）均较正常人减低,而ＰＳＤ的ＨＦ峰值却均较正常人增高,该ＨＲＶ 变化特征的显著性依上述左室构型顺序呈现进行性增强。结论：交感与副交感神经的双重损害参与了高血压的左室重构机制,且其损害程度可能伴随左室重构过程的进行而加重     

左心室质量及几何模式对左心室功能的影响

目的 探讨左心室质量(LVM)及几何模式对左心室功能的影响。方法 根据相对室壁厚度(RWT)>0.43和≤0.43将170例高血压患者分为向心性模式组和离心性模式组,分别作超声心动图检测。结果 向心性模式组的EF明显高于离心性模式组,而前者E、E/A明显低于后者。单变量及多变量回归分析均显示EF与LVM及RWT相关,E/A在单变量分析时与RWT呈非常显著负相关,但在多变量分析时被剔出。结论 LVM及几何模式的改变均对左心室收缩功能产生明显的损害,几何模式的变化可能对左心室舒张功能也会产生不利影响。     

Relationship between left ventricular geometry and left atrial size and function in patients with systemic hypertension

BACKGROUND: Arterial hypertension determines distinct adaptive left ventricular geometric responses, which may differently affect left ventricular function and left atrial performance. OBJECTIVES: In this study, the effect of left ventricular geometry on left atrial size and function, and the relationship between left atrial size and left ventricular mass were assessed in 336 patients with systemic arterial hypertension who had undergone Doppler echocardiography. METHODS AND RESULTS: Patients were classified into concentric (110 patients with concentric left ventricular geometry defined as relative wall thickness > or = 0.44) and eccentric groups (226 patients with relative wall thickness < 0.44). Comparison to the latter, the former had greater left atrial size, left atrial ejection force, left ventricular mass and lower left ventricular midwall fractional shortening. Left ventricular concentric, rather than eccentric, geometry emerged by multivariate analysis as a factor independently associated with the highest degree of left atrial ejection force. Left atrial size was positively related to left ventricular mass in the whole population (r = 0.65, SEE = 6 ml, P < 0.00001). This relationship was maintained in the subgroups with concentric (r = 0.65, SEE = 6 ml, P < 0.00001) or eccentric geometry (r = 0.59, SEE = 6 ml, P < 0.00001). CONCLUSIONS: Our results indicate that the relationship of left ventricular geometry to both left atrial size and ejection force in hypertensive patients is relevant. Concentric left ventricular geometry is associated with greater left atrial size and ejection force than eccentric geometry, suggesting that increased left ventricular stiffness has a greater effect in stimulating left atrial performance than left ventricular end-systolic stress. The degree of left atrial enlargement similarly depends on left ventricular mass in patients with concentric and eccentric geometry.     

The effect of left ventricular geometry on myocardial performance index in hypertensive patients]

OBJECTIVE: The aim of this study was to investigate the relationship between the myocardial performance index (MPI) and left ventricular (LV) geometry in hypertensive patients. METHODS: The MPI, which is a marker of systolic and diastolic ventricular function, was measured in 64 hypertensive patients and in 15 healthy persons (Control). According to the value of relative wall thickness (RWT) and LV mass index (LVMI), hypertensive patients were subdivided into four groups: normal (N), 17 patients (26.6%); concentric remodeling (CR), 21 patients (32.8%); concentric hypertrophy (CH), 16 patients (25%); and eccentric hypertrophy (EH), 10 patients (15.6%). RESULTS: A higher MPI was found in all patient groups (N, 0.56+/-0.11; CR, 0.59+/-0.11; CH, 0.68+/-0.19; EH, 0.57+/-0.10) compared with the controls (0.44+/-0.09) (p=0.004, p<0.001, p<0.001 and p = 0.002, respectively). In the CH group, the MPI was also higher than in N, CR and EH groups (p=0.006, p<0.03 and p=0.009, respectively). No significant difference was found among N, CR and EH groups. The MPI was correlated with LVMI (r=0.28, p=0.014), RWT (r=0.24, p=0.035) and interventricular septum diastolic thickness (r=0.32, p=0.004). CONCLUSION: The systolic and diastolic LV functions are impaired in all subgroups of hypertensive patients according to their LV geometry compared to control group. This impairment is more advanced in patients with concentric hypertrophy than in those with the other LV geometric patterns.     

Left ventricular geometric patterns and QT dispersion in untreated essential hypertension

The spectrum of left ventricular adaptation to hypertension, different types of hypertrophy patterns, and QT dispersion in different types of hypertrophy was investigated in 107 patients with untreated essential hypertension and 30 age- and gender-matched normal adults studied by 12-derivation electrocardiogram (ECG), two-dimensional, and M-mode echocardiography.Left ventricular mass (LVM), body mass index, total peripheral resistance (TPR), relative wall thickness (RWT), and QT dispersion were found to be statistically significantly higher in the hypertension group (P < .001 for all). Among hypertensive patients, 41.1% had both normal LVM and RWT, here called normal left ventricle in hypertension; 10.3% had concentric hypertrophy with increased LVM and RWT; 14.95% had eccentric hypertrophy with increased LVM and normal RWT; and 32.7% had concentric remodeling with normal LVM and increased RWT.Echocardiographically derived cardiac index was higher in the concentric hypertrophy and eccentric hypertrophy patterns (P = .002 and P < .0001, respectively), whereas TPR was higher in the concentric hypertrophy and concentric remodeling patterns (P = .017 and .02, respectively).QT dispersion values were found to be increased in the hypertensive group (P = .001), whereas similar values were calculated for different types of hypertrophy patterns.We conclude that the more common types of ventricular adaptation to essential hypertension are eccentric hypertrophy and concentric remodeling. Concentric hypertrophy is found to be associated with both volume and pressure overload, whereas eccentric hypertrophy is associated with volume overload only and concentric remodeling is associated with pressure overload. But different left ventricular geometric patterns seem to have similar effects on QT dispersion.     

Effects of spironolactone during an angiotensin II receptor blocker treatment on the left ventricular mass reduction in hypertensive patients with concentric left ventricular hypertrophy.

BACKGROUND: Angiotensin II receptor blockers (ARB) are now commonly used to treat hypertension because of their beneficial effects on cardiovascular remodeling. However, ARB treatment can not inhibit the left ventricular (LV) remodeling sufficiently, which may be related with aldosterone secretion. To inhibit the action of aldosterone during ARB treatment, the additional effects of an aldosterone blocker and spironolactone (SPRL) on LV hypertrophy in patients with essential hypertension was studied. METHODS AND RESULTS: The patients with essential hypertension were randomly divided into 2 groups; 1 group was treated with an ARB, candesartan (8 mg/day), for 1 year (ARB group) and other group was treated with the ARB for the first 6 months and with the ARB plus SPRL (25 mg/day) for the next 6 months (combination group). Seventy patients who underwent echocardiography every 6 months were analyzed and were also classified into 4 subgroups of LV geometric pattern according to the LV mass index (LVMI) and the relative wall thickness (RWT). The ARB treatment and the addition of SPRL significantly reduced the blood pressure, however, both treatments did not affect the LV geometry in both groups. The ARB treatment in the subgroups of concentric LV remodeling (RWT>or=0.45 and LVMI<125) and concentric LV hypertrophy (RWT>or=0.45 and LVMI>or=125) significantly reduced RWT. However, ARB treatment in all subgroups did not affect LVMI. The addition of SPRL only in the concentric LV hypertrophy subgroup significantly reduced the LVMI, despite similar changes in blood pressure. CONCLUSIONS: These results indicated that the addition of SPRL treatment during the ARB treatment and conventional treatments is clinically useful to reduce the LVMI in hypertensive patients with concentric LV hypertrophy; however, does not improve the eccentric LV hypertrophy.     

Effect of electrocardiographic left ventricular hypertrophy on left ventricular systolic function in systemic hypertension (The LIFE Study). Losartan Intervention For Endpoint

Left ventricular (LV) ejection fraction is normal in most patients with uncomplicated hypertension, but the prevalence and correlates of decreased LV systolic chamber and myocardial function, as assessed by midwall mechanics, in hypertensive patients identified as being at high risk by the presence of LV hypertrophy on the electrocardiogram has not been established. Therefore echocardiograms were obtained in 913 patients with stage I to III hypertension and LV hypertrophy determined by electrocardiographic (Cornell voltage duration or Sokolow-Lyon voltage) criteria after 14 days' placebo treatment. The 913 patients' mean age was 66 years, and 42% were women. Fourteen percent had subnormal LV endocardial shortening, 24% had subnormal midwall shortening, and 13% had reduced stress-corrected midwall shortening. Nineteen percent had normal LV geometry, 11% had concentric remodeling, 47% had eccentric hypertrophy, and 23% had concentric hypertrophy. LV systolic performance evaluated by LV endocardial shortening and midwall shortening was impaired in 10% of patients with normal geometry, 20% with concentric remodeling, 27% with eccentric hypertrophy, and 42% with concentric hypertrophy. Relative wall thickness, an important independent correlate of LV chamber function, was related directly to endocardial shortening and negatively to midwall shortening and stress-corrected midwall shortening. LV mass was the strongest independent correlate of impaired endocardial shortening, midwall shortening, or both. In hypertensive patients with electrocardiographic LV hypertrophy, indexes of systolic performance are subnormal in 10% to 42% with different LV geometric patterns. Depressed endocardial shortening is most common in patients with eccentric LV hypertrophy, whereas impaired midwall shortening is most prevalent in patients with concentric remodeling or hypertrophy. Thus, in hypertensive patients with electrocardiographic LV hypertrophy, impaired LV performance occurs most often, and is associated with greater LV mass and relative wall thickness and may contribute to the high rate of cardiovascular events.     

Midwall myocardial shortening in athletic left ventricular hypertrophy

BACKGROUND: Patients with pathological left ventricular hypertrophy have depressed midwall systolic shortening in spite of normal indices of left ventricular chamber function and a reduced midwall function has been observed to be an independent predictor of cardiovascular risk. Whether midwall shortening is depressed in physiological hypertrophy is unknown. METHODS: Forty-two subjects, 27 athletes and 15 age- and sex-matched normal control subjects (group 1) were studied. The athletes were divided into those with eccentric hypertrophy (group 2) and those with concentric hypertrophy (group 3). Systolic left ventricular function was assessed at the midwall and endocardium using two-dimensional echocardiography in all subjects. RESULTS: Left ventricular mass index was significantly greater in both athletic groups than in controls (group 1, 101+/-5.8 g/m(2), group 2, 141+/-11.1*, group 3, 155+/-5.8*; *P<0.01 compared with group 1). Left ventricular systolic function assessed at the endocardium was similar among all three groups (ejection fraction: group 1, 66.2+/-2.38, group 2, 66.8+/-1.44, group 3, 63.7+/-1.66%; endocardial fractional shortening: group 1, 37.1+/-1.71, group 2, 37.6+/-1.13, group 3, 35.1+/-1.25%). However, fractional shortening at the midwall was reduced in the concentric hypertrophy athletes compared with the other two groups (midwall fractional shortening: group 1, 21.9+/-1.1, group 2, 21.9+/-0.86, group 3, 18.4+/-0.96*%; P<0.05 compared with groups 1 and 2). CONCLUSION: Subjects with physiological concentric hypertrophy have depressed midwall fractional shortening. This suggests that the observed discrepancy between midwall and endocardial shortening in patients with left ventricular hypertrophy is likely to be a function of the geometry and not necessarily a reflection of pathology within the myocardium.     

Left ventricular hypertrophy and geometry in untreated essential hypertension is associated with blood levels of aldosterone and procollagen type III amino-terminal peptide.

BACKGROUND: The present study examined the role of aldosterone in left ventricular hypertrophy (LVH) and geometry in patients with untreated essential hypertension (EHT), and investigated the contribution of myocardial fibrosis to the process of LVH. METHODS AND RESULTS: The relationship of the plasma aldosterone concentration (PAC) to LVH and left ventricular (LV) geometry was investigated in 57 consecutive patients with untreated EHT. PAC correlated with both LV mass index (LVMI: r=0.46, p=0.0004) and relative wall thickness (RWT: r=0.33, p=0.013). In patients with LVH (LVMI > or =125 g/m(2)), the serum concentration of procollagen type III amino-terminal peptide (PIIINP), a marker of myocardial fibrosis, correlated with RWT (r=0.46, p=0.029). These patients were divided into 2 groups: concentric hypertrophy (CH) with RWT > or =0.44, and eccentric hypertrophy (EH) with RWT <0.44. The serum PIIINP concentration was significantly higher in the CH group than in the EH group (0.52+/-0.02 ng/ml vs 0.44+/-0.03 ng/ml, respectively; p<0.05). CONCLUSIONS: Aldosterone may be involved in LVH and LV geometry, particularly in the development of CH. Myocardial fibrosis seems more strongly involved in the hypertrophic geometry of CH than with EH.     

Assessment of left ventricular function by the midwall fractional shortening/end-systolic stress relation in human hypertension

Objectives. This study examined left ventricular performance in relatively unselected hypertensive patients by use of physiologically appropriate midwall shortening/end-systolic stress relations.Background. Supranormal left ventricular function has been reported in hypertensive patients, possibly due to an artifact of mismatching endocardial rather than midwall fractional shortening to mean left ventricular end-systolic stress.Methods. Samples of 474 hypertensive patients (150 women, 324 men) and 140 normal subjects (68 women, 72 men) were drawn from a large urban employed population. The inverse relations (p < 0.0001) of both echocardiographic endocardial and midwall fractional shortening to end-systolic stress in normal subjects were used to calculate the ratios of observed to predicted endocardial and midwall fractional shortening in hypertensive patients. Midwall shortening was calculated from an elliptic model, taking into account the epicardial migration of the midwall during systole.Results. Use of midwall fractional shortening in hypertensive patients reduced the proportion of patients with function above the 95th percentile of normal from 22% to 4% (p < 0.0001) and fractional shortening as a percent of predicted from 107% (p < 0.001 vs. 100% in normotensive control subjects) to 95% (p < 0.0001; p < 0.001 vs. 101% in normotensive control subjects). Midwall shortening was below the 5th percentile of normal in 16% of hypertensive patients instead of 2% with endocardial shortening (p < 0.0001): They tended to be older than other hypertensive patients and had concentric left ventricular hypertrophy. Among hypertensive patients, these with concentric left ventricular hypertrophy or remodeling had reduced midwall shortening as a percent of predicted from end-systolic stress (p < 0.0001).Conclusions. Use of the physiologically more appropriate mid-wall shortening/end-systolic stress relation 1) markedly reduces the proportion of hypertensive subjects identified as having high endocardial left ventricular functions; and 2) identifies a substantial subgroup of patients with reduced left ventricular function who have concentric geometry of the left ventricle, a pattern associated with high cardiovascular risk.     

Three-dimensional analysis of left ventricular geometry using magnetic resonance imaging: feasibility and comparison with echocardiographic analysis

OBJECTIVES: Reliability of left ventricular geometry assessed by echocardiography (Echo) using an assumed left ventricular mass (LVM) and one-dimensional eccentricity (relative wall thickness: RWT), remains questionable. This study evaluated the feasibility of three-dimensional left ventricular geometric analysis using magnetic resonance imaging (MRI). METHODS: Echocardiography and MRI were performed on 55 patients with hypertension. LVM was calculated using 0.8 (American Society of Echocardiography-cube LVM) + 0.6 g for Echo and the slice summation method for MRI. Eccentricity was determined by RWT (septal wall thickness + posterior wall thickness/left ventricular inner diameter) for Echo and LVM/1.05/left ventricular end-diastolic volume (LVEDV) ratio [MRI-mass volume/cavity (M/C) ratio] for MRI. Left ventricular geometry was classified into four patterns according to the presence/absence of left ventricular hypertrophy and abnormal/normal eccentricity (partition value: RWT = 0.44, MRI; M/C ratio = 2.0), and the patient distribution was compared between the two methods. RESULTS: Although the mean values for LVM were similar, the mean value for LVEDV by echocardiography was significantly higher (p < 0.0001) and the mean M/C ratio was significantly lower (r = 0.004) than those by MRI. There were widely dispersed LVM values at higher underlying values of LVM and significant correlations between MRI-LVEDV and MRI-LVM (r = 0.87) and between Echo-LVEDV and Echo-LVM (r = 0.75). There was a significant difference in patient distribution according to left ventricular geometric pattern between the two methods (p < 0.01). Concentric (n = 18) and eccentric hypertrophy (n = 12) were dominant patterns in Echo analysis, and concentric hypertrophy (n = 23) and concentric remodeling (n = 21) were dominant in MRI analysis. The left ventricular geometric patterns were different in 32 patients (58.0%). Inadequate LVEDV values in Echo were the primary cause of this phenomenon. CONCLUSIONS: Left ventricular geometric analysis by Echo results in inaccurate values. Three-dimensional left ventricular geometric analysis using MRI provides more accurate information about left ventricular geometry.     

Relationship between Tei index of myocardial performance and left ventricular geometry in Nigerians with systemic hypertension

Introduction

Left ventricular geometry is associated with cardiovascular events and prognosis. The Tei index of myocardial performance is a combined index of systolic and diastolic dysfunction and has been shown to be a predictor of cardiovascular outcome in heart diseases. The relationship between the Tei index and left ventricular geometry has not been well studied. This study examined the association between the Tei index and left ventricular geometry among hypertensive Nigerian subjects.

Methods

We performed echocardiography on 164 hypertensives and 64 control subjects. They were grouped into four geometric patterns based on left ventricular mass and relative wall thickness. The Tei index was obtained from the summation of the isovolumic relaxation time and the isovolumic contraction time, divided by the ejection time. Statistical analysis was done using SPSS 16.0.

Results

Among the hypertensive subjects, 68 (41.4%) had concentric hypertrophy, 43 (26.2%) had concentric remodelling, 24 (14.6%) had eccentric hypertrophy, and 29 (17.7%) had normal geometry. The Tei index was significantly higher among the hypertensives with concentric hypertrophy (CH), concentric remodelling (CR) and eccentric hypertrophy (EH) compared to the hypertensives with normal geometry (0.83 ± 1.0, 0.71 ± 0.2, 0.80 ± 0.2 vs 0.61 ± 0.2, respectively). The Tei index was higher among hypertensives with CH and EH than those with CR. Stepwise regression analysis showed that the Tei index was related to ejection fraction, fractional shortening and mitral E/A ratio.

Conclusion

Among Nigerian hypertensives, LV systolic and diastolic functions (using the Tei index) were impaired in all subgroups of hypertensive patients according to their left ventricle geometry compared to the control group. This impairment was more advanced in patients with concentric and eccentric hypertrophy.