DOI QR코드

DOI QR Code

Improvement in Left Ventricular Systolic Dyssynchrony in Hypertensive Patients After Treatment of Hypertension

  • Published : 2011.01.30

Abstract

Background and Objectives: Left ventricular (LV) dyssynchrony has been commonly detected among hypertensive patients with normal LV systolic function and no evidence of congestive heart failure. The purpose of our study was to assess the changes in LV systolic dyssynchrony ($SDS_{LV}$) among hypertensive patients after antihypertensive treatment, and to determine the relationship between $SDS_{LV}$ and other conventional echocardiographic parameters. Subjects and Methods: Forty one hypertensive patients with normal LV ejection fraction were enrolled. By performing a conventional echocardiographic study, the $SDS_{LV}$ was measured as the time difference between the shortest and longest time of the peak myocardial systolic velocities among 12 segments of the basal and mid-levels of the 3 apical views, and radial dyssynchrony of the basal ($RDS_{base}$) and mid-levels ($RDS_{mid}$) measured as the time difference between the earliest and latest peak values on the radial strain curves of each level of the parasternal short-axis views. Results: Compared to baseline after six months of antihypertensive treatment, the $SDS_{LV}$ improved significantly (48.7${\pm}$37.9 ms vs. 29.5${\pm}$34.1 ms, p=0.020). Also the $RDS_{base}$ and $RDS_{mid}$ improved significantly in respect to the baseline values (129.9${\pm}$136.3 ms vs. 38.8${\pm}$45.4 ms, p=0.002 and 75.2${\pm}$63.8 ms vs. 28.2${\pm}$37.7 ms, respectively, p<0.001). Conclusion: The severity of $SDS_{LV}$ improved with antihypertensive treatment, and was associated with the regression of LV mass. Furthermore, it might precede improvement in the mitral inflow pattern, as assessed by conventional echocardiography, so that early detection of the benefit of antihypertensive treatment may be possible.

Keywords

References

  1. Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and dia-stolic heart failure: I. diagnosis, prognosis, measurements of diastolic function. Circulation 2002;105:1387-93. https://doi.org/10.1161/hc1102.105289
  2. Poulsen SH, Anderson NH, Ivarsen PI, Mogensen CE, Egeblad H. Doppler tissue imaging reveals systolic dysfunction in patients with hy-pertension and apparent "isolated" diastolic dysfunction. J Am Soc Echocardiogr 2003;16:724-31. https://doi.org/10.1016/S0894-7317(03)00403-6
  3. Aurigemma GP, Silver KH, Priest MA, Gaasch WH. Geometric ch-anges allow normal ejection fraction despite depressed myocardial sh-ortening in hypertensive left ventricular hypertrophy. J Am Coll Cardiol 1995;26:195-202. https://doi.org/10.1016/0735-1097(95)00153-Q
  4. Penicka M, Bartunek J, De Bruyne B, et al. Improvement of left ventricular function after cardiac resynchronization therapy is predicted by tissue Doppler imaging echocardiography. Circulation 2004;109: 978-83. https://doi.org/10.1161/01.CIR.0000116765.43251.D7
  5. Leclercq C, Faris O, Tunin R, et al. Systolic improvement and mechanical resynchronization does not require electrical synchrony in the dilated failing heart with left bundle-branch block. Circulation 2002;106:1760 -3. https://doi.org/10.1161/01.CIR.0000035037.11968.5C
  6. Wang J, Kurrelmeyer KM, Torre-Amione G, Nagueh SF. Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy. J Am Coll Cardiol 2007;49:88-96. https://doi.org/10.1016/j.jacc.2006.10.023
  7. Yu C-M, Zhang Q, Yip GWD, et al. Diastolic and systolic asynchrony in patients with diastolic heart failure. J Am Coll Cardiol 2007;49: 97-105. https://doi.org/10.1016/j.jacc.2006.10.022
  8. Yang B, Chettiveettil D, Jones F, Aguero M, Lewis JF. Left ventricular dyssynchrony in hypertensive patients without congestive heart failure. Clin Cardiol 2008;31:597-601. https://doi.org/10.1002/clc.20350
  9. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. JAMA 2003;289:2560-72. https://doi.org/10.1001/jama.289.19.2560
  10. McKee PA, Castelli WP, McNamara PM, Kannel WB. The natural his-tory of congestive heart failure: the Framingham study. N Engl J Med 1971;285:1441-6. https://doi.org/10.1056/NEJM197112232852601
  11. Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Dop-pler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation 2000;102:1788-94. https://doi.org/10.1161/01.CIR.102.15.1788
  12. Suffoletto MS, Dohi K, Cannesson M, Seba S, Gorcsan J 3rd. Novel speckle tracking radial strain from routine black-and-white echocardiographic images to quantify dyssynchrony and predict response to cardiac resynchronization therapy. Circulation 2006;113:960-8. https://doi.org/10.1161/CIRCULATIONAHA.105.571455
  13. Gorcsan J 3rd, Tanabe M, Bleeker GB, et al. Combined longitudinal and radial dyssynchrony predicts ventricular response after resynchronization therapy. J Am Coll Cardiol 2007;50:1476-83. https://doi.org/10.1016/j.jacc.2007.06.043
  14. Sokolow M, Lyon TP. The ventricular complex in ventricular hypertrophy as obtained by unipolar precordial and limb leads. Am Heart J 1949;37:161-86. https://doi.org/10.1016/0002-8703(49)90562-1
  15. Nagueh SF. Mechanical dyssynchrony in congestive heart failure. J Am Coll Cardiol 2008;51:18-22. https://doi.org/10.1016/j.jacc.2007.08.052
  16. Hawkins NM, Petrie MC, MacDonald MR, Hogg JK, McMurray JJ. Selecting patients for cardiac resynchronization therapy: electrical or mechanical dyssynchrony? Eur Heart J 2006;27:1270-81. https://doi.org/10.1093/eurheartj/ehi826
  17. Bleeker GB, Holman ER, Steendijk P, et al. Cardiac resynchronization therapy in patients with a narrow QRS complex. J Am Coll Cardiol 2006;48:2243-50. https://doi.org/10.1016/j.jacc.2006.07.067
  18. Kass DA. An epidemic of dyssynchrony: but what does it mean? J Am Coll Cardiol 2008;51:12-7. https://doi.org/10.1016/j.jacc.2007.09.027
  19. Wang J, Kurrelmeyer KM, Torre-Amione G, Nagueh SF. Systolic and diastolic dyssynchrony in patients with diastolic heart failure and the effect of medical therapy. J Am Coll Cardiol 2007;49:88-96. https://doi.org/10.1016/j.jacc.2006.10.023
  20. Wang YC, Hwang JJ, Lai LP, et al. Coexistence and exercise exacerbation of intraleft ventricular contractile dyssynchrony in hypertensive patients with diastolic heart failure. Am Heart J 2007;154:278-84. https://doi.org/10.1016/j.ahj.2007.04.008

Cited by

  1. Impact of antihypertensive treatment on left ventricular systolic dyssynchrony in treatment-naïve hypertensive patients vol.35, pp.6, 2012, https://doi.org/10.1038/hr.2012.28
  2. Left ventricular systolic dyssynchrony index and endothelial dysfunction parameters as subclinical predictors of cardiovascular involvement in patients with beta‐thalassemia major vol.38, pp.6, 2021, https://doi.org/10.1111/echo.15067