Cardiac performance in elderly hypertensives with left ventricular hypertrophy]

To assess the cardiac functional reserve of elderly hypertensives with left ventricular hypertrophy (LVH), we studied cardiac functions after isometric exercise and beta stimulation. Forty-two elderly hypertensives and 15 normotensives (NC group) were recruited for the study. Hypertensives were divided into 19 hypertensives with LVH (LVMI greater than 130 g/m2: H1 group) and 23 without LVH (H2 group). Echocardiographic studies were performed before and after isometric exercise (handgrip, HG) and isoproterenol administration (ISP). We measured LV mass index (LVMI), fractional shortening (FS), isovolumetric relaxation time (IRT), and the ratio of early and late diastolic transmitral flow velocity (A/E). FS at rest in the H1 group was significantly higher than in the H2 and NC groups. In the H1 group, IRT was elongated and A/E was greater than in the NC group, which indicated impaired diastolic function in the H1 group. After HG, FS in the H1 group significantly decreased while it did not change in the H2 or NC groups. FS increased in all three groups after the infusion of ISP, although the increment of FS was smaller in the H1 group. In conclusion, diastolic function was impaired whereas systolic function was supranormal at rest in the hypertrophied heart of the elderly hypertensives, and when exercise or pharmacological stress was loaded, the systolic function deteriorated, suggesting the impairment of cardiac reserve in those patients.