Is there a latent left ventricular dysfunction in hypertensive patients with preserved ejection fraction ?

Abstract

Introduction:Early detection of left ventricular(LV) dysfunction may represent a clinical finding that would justify aggressive treatment aimed to reduce cardiovascular morbidity and mortality.
Aim: To evaluate longitudinal contractility in patients with essential hypertension and preserved LV ejection fraction (EF), in an attempt to detect latent impairment of LV systolic function.
Methods: Prospective case-control study, carried out on 121 (67 male/54 female) hypertensive patients (HTN group) with preserved EF and without any symptoms of heart failure and 39 age- and gender-matched healthy subjects as a control group. Conventional echocar¬diographic study, as well as 2D Longitudinal strain imaging by 2D-speckle tracking echocardiography (2D-STE), were performed.
Results:Mean age of patients was 60,48 ± 10.5 years old. The LVend-diastolic diameter and LVEF were comparable between the two groups. Hypertensive patients had greater septal thickness, left ventricular mass,and maximum left atrium volume (p respectively at 0.02; 0.04; and 0.01).
Only 20 patients (16.5%) had left ventricular hypertrophy (LVH). The architecture of LV was normal in 57.8 % (n=70) patients. A statistically significant difference between the two groups was found for all diastolic function parameters except Em /Ea ratio and DTEm.
In comparison with normal con¬trols, GLS was significantly attenuated in patients with HTN (-17.69 ± 4.06 % versus -22.70 ± 5.02% in controls (p=0.000) and 67 (55.4%) hypertensive patients had a GLS<-20% (in absolute value). The decrease of GLS was more marked in the hypertensive group with left ventricular hypertrophy.
Conclusion:
The results of our study confirmed that GLS is a sensitive biomarker of subclinical myocardial dysfunction in hypertensive patients, this suggests that identifying patients at higher risk for heart failure and earlier inter¬vention may be beneficial.