Evaluation of systolic properties in hypertensive patients with different degrees of diastolic dysfunction and normal ejection fraction

Sebastiano Sciarretta, Francesco Paneni, Giuseppino M. Ciavarella, Luciano De Biase, Francesca Palano, Rossella Baldini, Giovanni Quarta, Giuliano Tocci, Umberto Benedetto, Andrea Ferrucci, Speranza Rubattu, Giovanni De Simone, Massimo Volpe

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18 Citations (Scopus)

Abstract

Background: Left ventricular (LV) diastolic dysfunction (DD) associated with a preserved ejection fraction (EF) is a frequent alteration in hypertensive patients, usually considered an impairment of the diastolic phase alone. However, because systole and diastole are strictly correlated to one another, it is possible that hypertensive patients with isolated DD may also present with initial abnormalities of LV systolic properties, particularly those presenting with a more severe degree of DD. We performed a multiparametric echocardiographic assessment of LV systolic properties in patients without cardiovascular diseases, with preserved EF and different degrees of DD. Methods: We evaluated 1,073 hypertensive subjects showing EF >55% and no overt heart disease. Results: A total of 362 patients had normal diastolic function (N), 609 displayed delayed relaxation pattern (DR), and 102 presented a pseudonormal filling pattern (PN). Albeit most of the subjects with DD (DR, PN) had systolic indexes within normal range, they presented a significant reduction of index stroke volume (SV) (P <0.0001) and stroke work (SW) (P <0.0001), EF (P <0.01), midwall shortening (MFS) (P <0.0001), circumferential end-systolic stress-corrected MFS (cESS-MFS) (P <0.001), and tissue Doppler (TD) systolic velocity (P <0.0001) as compared to the N group, particularly the PN group. After adjustments, the reductions of LV systolic indexes were still significantly related to DD, particularly to PN. Conclusions: Our results suggest a relation between LV systolic and diastolic properties in patients with normal EF. They also highlight the early onset of a preclinical reduction of systolic properties in patients with "isolated" DD, which is related to the degree of dysfunction.

Original languageEnglish
Pages (from-to)437-443
Number of pages7
JournalAmerican Journal of Hypertension
Volume22
Issue number4
DOIs
Publication statusPublished - Apr 2009

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Diastole
Systole
Left Ventricular Dysfunction
Stroke Volume
Heart Diseases
Reference Values
Cardiovascular Diseases
Stroke

ASJC Scopus subject areas

  • Internal Medicine

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Evaluation of systolic properties in hypertensive patients with different degrees of diastolic dysfunction and normal ejection fraction. / Sciarretta, Sebastiano; Paneni, Francesco; Ciavarella, Giuseppino M.; De Biase, Luciano; Palano, Francesca; Baldini, Rossella; Quarta, Giovanni; Tocci, Giuliano; Benedetto, Umberto; Ferrucci, Andrea; Rubattu, Speranza; De Simone, Giovanni; Volpe, Massimo.

In: American Journal of Hypertension, Vol. 22, No. 4, 04.2009, p. 437-443.

Research output: Contribution to journalArticle

Sciarretta, Sebastiano ; Paneni, Francesco ; Ciavarella, Giuseppino M. ; De Biase, Luciano ; Palano, Francesca ; Baldini, Rossella ; Quarta, Giovanni ; Tocci, Giuliano ; Benedetto, Umberto ; Ferrucci, Andrea ; Rubattu, Speranza ; De Simone, Giovanni ; Volpe, Massimo. / Evaluation of systolic properties in hypertensive patients with different degrees of diastolic dysfunction and normal ejection fraction. In: American Journal of Hypertension. 2009 ; Vol. 22, No. 4. pp. 437-443.
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AU - Sciarretta, Sebastiano

AU - Paneni, Francesco

AU - Ciavarella, Giuseppino M.

AU - De Biase, Luciano

AU - Palano, Francesca

AU - Baldini, Rossella

AU - Quarta, Giovanni

AU - Tocci, Giuliano

AU - Benedetto, Umberto

AU - Ferrucci, Andrea

AU - Rubattu, Speranza

AU - De Simone, Giovanni

AU - Volpe, Massimo

PY - 2009/4

Y1 - 2009/4

N2 - Background: Left ventricular (LV) diastolic dysfunction (DD) associated with a preserved ejection fraction (EF) is a frequent alteration in hypertensive patients, usually considered an impairment of the diastolic phase alone. However, because systole and diastole are strictly correlated to one another, it is possible that hypertensive patients with isolated DD may also present with initial abnormalities of LV systolic properties, particularly those presenting with a more severe degree of DD. We performed a multiparametric echocardiographic assessment of LV systolic properties in patients without cardiovascular diseases, with preserved EF and different degrees of DD. Methods: We evaluated 1,073 hypertensive subjects showing EF >55% and no overt heart disease. Results: A total of 362 patients had normal diastolic function (N), 609 displayed delayed relaxation pattern (DR), and 102 presented a pseudonormal filling pattern (PN). Albeit most of the subjects with DD (DR, PN) had systolic indexes within normal range, they presented a significant reduction of index stroke volume (SV) (P <0.0001) and stroke work (SW) (P <0.0001), EF (P <0.01), midwall shortening (MFS) (P <0.0001), circumferential end-systolic stress-corrected MFS (cESS-MFS) (P <0.001), and tissue Doppler (TD) systolic velocity (P <0.0001) as compared to the N group, particularly the PN group. After adjustments, the reductions of LV systolic indexes were still significantly related to DD, particularly to PN. Conclusions: Our results suggest a relation between LV systolic and diastolic properties in patients with normal EF. They also highlight the early onset of a preclinical reduction of systolic properties in patients with "isolated" DD, which is related to the degree of dysfunction.

AB - Background: Left ventricular (LV) diastolic dysfunction (DD) associated with a preserved ejection fraction (EF) is a frequent alteration in hypertensive patients, usually considered an impairment of the diastolic phase alone. However, because systole and diastole are strictly correlated to one another, it is possible that hypertensive patients with isolated DD may also present with initial abnormalities of LV systolic properties, particularly those presenting with a more severe degree of DD. We performed a multiparametric echocardiographic assessment of LV systolic properties in patients without cardiovascular diseases, with preserved EF and different degrees of DD. Methods: We evaluated 1,073 hypertensive subjects showing EF >55% and no overt heart disease. Results: A total of 362 patients had normal diastolic function (N), 609 displayed delayed relaxation pattern (DR), and 102 presented a pseudonormal filling pattern (PN). Albeit most of the subjects with DD (DR, PN) had systolic indexes within normal range, they presented a significant reduction of index stroke volume (SV) (P <0.0001) and stroke work (SW) (P <0.0001), EF (P <0.01), midwall shortening (MFS) (P <0.0001), circumferential end-systolic stress-corrected MFS (cESS-MFS) (P <0.001), and tissue Doppler (TD) systolic velocity (P <0.0001) as compared to the N group, particularly the PN group. After adjustments, the reductions of LV systolic indexes were still significantly related to DD, particularly to PN. Conclusions: Our results suggest a relation between LV systolic and diastolic properties in patients with normal EF. They also highlight the early onset of a preclinical reduction of systolic properties in patients with "isolated" DD, which is related to the degree of dysfunction.

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