Changes in midwall systolic performance and cardiac hypertrophy reduction in hypertensive patients

Objective To investigate changes in left ventricular (LV) performance, as e valuated by measurement of midwall LV fractional shortening (FS), after red uction of cardiac hypertrophy. Design and methods Echocardiographic evaluation of LV anatomy and function was performed by M-mode echocardiography at baseline, after long-term antih ypertensive therapy, and after treatment withdrawal in 68 asymptomatic hype rtensive patients (50 males, 18 females, age range 22-62 years). Patients w ere divided according to the presence of LV hypertrophy (LVH) at baseline ( LV mass index, LVMI, greater than or equal to 51 g/m(2.7)). Results At baseline patients with concentric (relative wall thickness > 0.4 4) LV hypertrophy (n = 38) or remodelling (n = 7) had reduced midwall short ening with respect to patients with normal LV geometry (n = 4) or eccentric LVH (n = 19); no differences were observed for endocardial FS. After long- term treatment (average 15 months), in 11 patients LV mass remained within normal limits, in 45 patients LVH reduction was obtained, while in 12 patie nts LV mass remained persistently elevated. Midwall FS was significantly in creased in patients with reduction of LVH both during treatment and after w ithdrawal of treatment, while it remained significantly lower in patients w ith persistently elevated LV mass. Changes in midwall fractional shortening were independently associated with modifications in relative wall thicknes s (P<0.00001), with changes in end-diastolic dimensions (P<0.0001) and thos e of LVMI (P<0.02) as shown by multivariate analysis. Conclusion LV midwall systolic performance significantly improved after red uction of LVH, even in the presence of high blood pressure values. Modifica tions in relative wall thickness are more independently associated with cha nges, in LV diastolic dimensions and mass, to midwall improvement. J Hypert ens 18:1651-1656 (C) 2000 Lippincott Williams & Wilkins.