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Is left ventricular postsystolic long-axis shortening a marker for severity of hypertensive heart disease?

      Detection of the cardiac sequelae of hypertension plays an important role in the risk assessment of patients with elevated arterial pressure. Prognosis may vary greatly between groups of patients with similar blood pressures,
      • De Simone G.
      • Devereux R.B.
      • Koren M.J.
      • Mensah G.A.
      • Casale P.N.
      • Laragh J.H.
      Midwall left ventricular mechanics. An independent predictor of cardiovascular risk in arterial hypertension.
      and differentiating among these groups is difficult. A common pattern among hypertensive patients is impaired left ventricular (LV) diastolic function with preserved systolic function, as measured by many conventional parameters, such as LV ejection fraction.
      • Zabalgoitia M.
      Left ventricular mass and function in primary hypertension.
      In contrast, systolic function along the ventricular long axis has been shown to be abnormal in many hypertensive subjects, even when the LV ejection fraction is normal.
      • Wandt B.
      • Bojö L.
      • Tolagen K.
      • Wranne B.
      Echocardiographic assessment of left ventricular ejection fraction in left ventricular hypertrophy.
      Analysis of mitral annulus motion (MAM) is the well-established method for assessing long-axis ventricular function.
      • Alam M.
      • Höglund C.
      Assessment by echocardiogram of left ventricular diastolic function in healthy subjects using the atrioventricular plane displacement.
      ,
      • Henein M.
      • Gibson D.
      Long axis function in disease.
      ,
      • Bruch C.
      • Schmermund A.
      • Marin D.
      • Kuntz S.
      • Bartel T.
      • Schaar J.
      • Erbel R.
      M-mode analysis of mitral annulus motion for detection of pseudonormalization of the mitral inflow pattern.
      ,
      • Alam M.
      • Wardell J.
      • Andersson E.
      • Samad B.A.
      • Nordlander R.
      Right ventricular function in patients with first inferior myocardial infarction assessment by tricuspid annular motion and tricuspid annular velocity.
      ,
      • Emilsson K.
      • Alam M.
      • Wandt B.
      The relation between mitral annulus motion and ejection fraction a nonlinear function.
      MAM has a proved incremental value to other conventional techniques in evaluating diastolic and systolic function in hypertensive patients.
      • Wandt B.
      • Bojö L.
      • Tolagen K.
      • Wranne B.
      Echocardiographic assessment of left ventricular ejection fraction in left ventricular hypertrophy.
      ,
      • Bojö L.
      • Wandt B.
      • Haaga S.
      How should we assess diastolic function in hypertension?.
      ,
      • Rodriguez L.
      • Garcia M.
      • Ares M.
      • Griffin B.P.
      • Nakatani S.
      • Thomas J.D.
      Assessment of mitral annular dynamics during diastole by Doppler tissue imaging comparison with mitral Doppler inflow in subjects without heart disease and in patients with left ventricular hypertrophy.
      Measurement of annular motion also allows detection of postsystolic shortening (PSS) along the LV long axis. This phenomenon has been observed with acute myocardial ischemia, and also in hypertensive patients with LV hypertrophy.
      • Jamal F.
      • Szilard M.
      • Kukulski T.
      • Liu X.S.
      • D’hooge J.
      • Bijnens B.
      • Rademakers F.
      • Hatle L.
      • Descheerder I.
      • Sutherland G.R.
      Changes in systolic and postsystolic wall thickening during acute coronary occlusion and reperfusion in closed-chest pigs implications for the assessment of regional myocardial function.
      ,
      • Skulstad H.
      • Edvardsen T.
      • Urheim S.
      • Rabben S.I.
      • Stugaard M.
      • Lyseggen E.
      • Ihlen H.
      • Smiseth O.A.
      Postsystolic shortening in ischemic myocardium active contraction or passive recoil?.
      ,
      • Pai R.G.
      • Gill K.S.
      Amplitudes, durations, and timings of apically directed left ventricular myocardial velocities II. Systolic and diastolic asynchrony in patients with left ventricular hypertrophy.
      To date, the potential importance of PSS in hypertensive heart disease has not been well defined. Therefore, the aim of this study was (1) to show the extent of PSS along the LV long axis in a group of hypertensive patients, and (2) to relate PSS to the severity of hypertensive heart disease.
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