Impaired midwall mechanics and biventricular hypertrophy in essential hypertension

Objective. Impaired left ventricular (LV) mechanics in human hypertension are strongly related to LV hypertrophy (LVH). In the present study, we investigated the relationship between LV mid-wall fractional shortening (MWS) and biventricular hypertrophy in uncomplicated essential hypertensives. Methods. A total of 328 hypertensive patients categorized in tertiles of MWS were considered for the analysis. All patients underwent routine and standardized echocardiographic examinations. Biventricular hypertrophy was defined by anterior right ventricular (RV) wall thickness ≥3.1 mm/m2 in men and ≥3.0 mm/m2 in women, combined with LV mass index (LVMI) ≥49 g/m2.7 in men and 45 g/m2.7 in women. Results. Biventricular hypertrophy was found in 21% of the study population. In the lowest MWS tertile, the likelihood of biventricular hypertrophy was 1.4- and 1.9-fold greater (p<0.05) than in the intermediate and highest one, respectively; this was not the case for isolated LVH or RV hypertrophy (RVH). In a multivariate analysis, MWS was significantly associated with LV mass index (β-0.181, p0.003) and RV wall thickness (β-0.171, p50.01). Conclusion. In systemic hypertension, a decrease in LV systolic performance may be related not only to LVH, but to the global cardiac involvement occurring in biventricular hypertrophy.