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Determinants of discrepancy between left ventricular chamber systolic performance and effective myocardial contractility in subjects with hypertension

Journal of Human Hypertension volume 20, pages 701–703 (2006)Cite this article

In patients with hypertension, a mismatch exists between left ventricular (LV) chamber systolic performance and effective LV myocardial contractility. Relative wall thickness (RWT), body mass index (BMI), LV wall stress and male gender are independent correlates of this discrepancy. Standard echocardiographic indices of endocardial performance such as ejection fraction (EF) and endocardial fractional shortening (eFS) overestimate systolic performance of LV circumferential fibers, which are mostly distributed in the midwall layers.1 Measurement of midwall fractional shortening (mFS) represents a more accurate method to quantify the effective LV systolic function, and adjustment of mFS to LV wall stress provides an afterload-independent estimate of LV myocardial contractility.2 The determination of mFS yields lower values than those obtained at the endocardium. The pathophysiological substrate of this discrepancy includes geometrical factors and mechanisms involving interaction among differently oriented layers.3 As a result of the alteration in LV geometry, this phenomenon is enhanced in LV pressure-overload, and this explains the evidence of normal or even hyperdynamic LV chamber function despite reduced midwall performance in many hypertensive patients.4 The presence of a mismatch between endocardial and midwall function in these subjects is clinically important, as it allows maintenance of LV pump performance despite intrinsic myocardial impairment.5 However, a direct evaluation of the difference between endocardial and midwall systolic function, and of its determinants, has never been performed.

To investigate factors contributing to this discrepancy, we studied 129 patients aged ⩾16 years, affected by stage II–III essential arterial hypertension. Patients were free from other cardiac disease, including ⩾2+ mitral regurgitation, mitral stenosis, aortic valve disease, overt coronary artery disease, hypertrophic cardiomyopathy, atrial fibrillation or other major arrhythmias, pacemaker implantation or heart transplantation. LV dimensions were measured by echocardiography in accordance with ASE recommendations. LV mass, RWT, eFS and EF were calculated using standard formulas. Circumferential end-systolic stress (cESS) was determined using the Gaasch formula.6 A LV cylindrical model was used to determine mFS.7 The eFS–cESS and mFS–cESS relations obtained in 40 age- and gender-matched controls were used to calculate predicted eFS and mFS in hypertensive patients. Stress-corrected eFS (SceFS) and mFS (ScmFS) were defined as the ratios between observed and predicted values, expressed in percentage. Stroke volume and mitral inflow parameters were measured by conventional Doppler imaging. The peak velocity of systolic (Sm) and early diastolic (Em) wave of the mitral annulus were measured by averaging the values obtained at the septal, lateral, inferior and anterior annular sites using tissue Doppler analysis.

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Authors and Affiliations

  1. Cardiology Operative Unit, S Andrea Hospital, La Spezia, Italy

    P Ballo

  2. Department of Cardiovascular Diseases, Università degli Studi, Siena, Italy

    S Mondillo

  3. Department of Clinical and Experimental Medicine, Federico II University, Naples, Italy

    M Galderisi

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  1. P Ballo
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  2. S Mondillo
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  3. M Galderisi
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Correspondence to P Ballo.

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Ballo, P., Mondillo, S. & Galderisi, M. Determinants of discrepancy between left ventricular chamber systolic performance and effective myocardial contractility in subjects with hypertension. J Hum Hypertens 20, 701–703 (2006). https://doi.org/10.1038/sj.jhh.1002055

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