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- Received July 15, 1993
- Revision received November 29, 1993
- Accepted December 8, 1993
- Published online May 1, 1994.
- Giovanni de Simone, MD, FACC,
- Richard B. Devereux, MD, FACC∗,
- Mary J. Roman, MD, FACC,
- Antonello Ganau, MD,
- Pier S. Saba, MD,
- Michael H. Alderman, MD and
- John H. Laragh, MD, FACC
- ↵∗Address for correspondence: Dr. Richard B. Devereux, Division of Cardiology, Box 222, The New York Hospital-Cornell Medical Center, 525 East 68th Street, New York, New York 10021.
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.
☆ This study was supported in part by Grant HL-18323 from the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
- Received July 15, 1993.
- Revision received November 29, 1993.
- Accepted December 8, 1993.