Key result
LV dyssynchrony affects ~48% of hypertensive patients with normal systolic function, correlating with LA volume.
Why the study?
It is unclear whether left ventricular dyssynchrony exists in hypertensive patients without clinical evidence of heart failure and with normal LV systolic function.
Cross-Sectional (n=42)
Left ventricular dyssynchrony is highly prevalent in hypertensive patients with normal systolic function prior to the onset of clinical heart failure, and its severity correlates with structural remodeling.
LV dyssynchrony occurs in nearly half of hypertensives without HF; leaves open whether it predicts progression or warrants targeted therapy.
BACKGROUND: Normal left ventricular (LV) systolic function is present in as many as 50% of patients with congestive heart failure. The majority of such patients have systemic hypertension. Recent studies have demonstrated LV dyssynchrony among patients with heart failure and normal systolic function. However, it is unclear whether such abnormalities exist in hypertensive patients who have not developed clinical evidence of heart failure. METHODS: Hospitalized patients with established hypertension undergoing echocardiography who met the following criteria were eligible for the study: LV ejection fraction (EF) >or= 50%, wall >or=11 mm, absence of valvular or known ischemic disease, and normal QRS duration. Complete 2-Dimensional and Doppler echocardiography studies with tissue Doppler imaging (TDI) were performed in all patients. Dyssynchrony was measured using time from QRS to peak systolic velocity on TDI (T-P) in 3 apical views. Normal values for dyssynchrony were established in a group of normotensive patients with normal echocardiography studies. RESULTS: The study included 42 patients (19 women, 23 men with a, mean age of 59.6 y (range 32-96 y). Left ventricular dyssynchrony was common, occurring in 20 of 42 patients (47.6%). Dyssynchrony assessed with the maximum T-P (T-Pmax) was significantly related to LV mass (r = 0.32, p = 0.036), left atrial volume (r = 0.59, p < 0.0001), and LV sphericity index (0.32, p = 0.037). Dyssynchrony was not related to age or LV filling pressure calculated from the Doppler study. CONCLUSIONS: Left ventricular dyssynchrony is common among hypertensive patients with normal LV systolic function and no evidence of congestive heart failure. The severity of LV dyssynchrony is related to the magnitude of LV hypertrophy, left atrial size, and LV remodeling.
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Yang et al. (2008) conducted a cross-sectional in Hypertension without congestive heart failure (n=42). Hypertension vs. Normotensive patients was evaluated on Left ventricular dyssynchrony. Left ventricular dyssynchrony occurred in 47.6% of hypertensive patients with normal LV systolic function, and its severity correlated significantly with left atrial volume (r=0.59, p<0.0001).
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