Document Detail

Relation of torsion and myocardial strains to LV ejection fraction in hypertension.
MedLine Citation:
PMID:  22421172     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The goal of this study was to define the mechanism of preserved ejection fraction (EF) despite depressed myocardial strains in hypertension (HTN).
BACKGROUND: Concentric left ventricular (LV) remodeling in HTN may have normal or supranormal EF despite depressed myocardial strains. The reason for such discordance is not clear. The aim of this study was to comprehensively evaluate the LV mechanics in a well-defined HTN population to define underlying reasons for such a paradox.
METHODS: Sixty-seven patients with resistant HTN and 45 healthy control subjects were studied by cardiac magnetic resonance imaging and tissue tagging with 3-dimensional analysis. Amplitude and directional vector of longitudinal (Ell), circumferential (Ecc), and principal strain for maximal shortening (E3) were computed at basal, mid, and distal LV levels, respectively. LV torsion, defined as the rotation angle of apex relative to base, and LV twist, which accounts for the effects of differential LV remodeling on torsion for comparison among the 2 groups, were also calculated.
RESULTS: LV mass index and LV mass/LV end-diastolic volume ratio were significantly higher in the HTN group compared with controls, consistent with concentric LV remodeling. Ell and Ecc were significantly decreased in amplitude with altered directional vector in HTN compared with controls. However, the amplitude of E3 was similar in the 2 groups. Torsion and twist were significantly higher in HTN, which was mainly due to increase in apical rotation. The HTN group demonstrated significantly increased LV wall thickening compared with controls that resulted in greater LVEF in the HTN group compared with controls (70% vs. 65%, p < 0.001, respectively).
CONCLUSIONS: In compensated LV remodeling secondary to HTN, there is increased LV wall thickening with preserved E3 and increased torsion compared with normal controls. This, therefore, contributes to supranormal LVEF in HTN despite depressed longitudinal and circumferential strains.
Mustafa I Ahmed; Ravi V Desai; Krishna K Gaddam; Bharath A Venkatesh; Shilpi Agarwal; Seidu Inusah; Steven G Lloyd; Thomas S Denney; David Calhoun; Louis J Dell'italia; Himanshu Gupta
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  5     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-03-16     Completed Date:  2012-08-09     Revised Date:  2014-09-19    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  273-81     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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MeSH Terms
Adaptation, Physiological
Antihypertensive Agents / therapeutic use
Biomechanical Phenomena
Case-Control Studies
Drug Resistance
Hypertension / diagnosis,  drug therapy,  physiopathology*
Linear Models
Magnetic Resonance Imaging
Middle Aged
Multivariate Analysis
Myocardial Contraction*
Prospective Studies
Stroke Volume*
Torsion, Mechanical
Ventricular Function, Left*
Ventricular Remodeling*
Grant Support
Reg. No./Substance:
0/Antihypertensive Agents
Comment In:
JACC Cardiovasc Imaging. 2012 Mar;5(3):282-4   [PMID:  22421173 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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