From 'compensatory' hypertensive left ventricular hypertrophy to heart failure: Is the transition so dramatic?
Cause of Death
Signal Processing, Computer-Assisted
Conventional indices of left ventricular (LV) systolic function (ejection fraction and fractional shortening) are normal or supranormal in asymptomatic hypertensive patients in relation to end-systolic stress (ESS). However, endocardial fiber shortening is conceptually mismatched to average ESS across the wall, which is applied at about the midwall. Recently, we have shown that relating midwall LV shortening instead of endocardial shortening to ESS eliminates evidence of LV systolic hyperfunction and instead identifies subnormal myocardial performance in one-sixth of asymptomatic established hypertensive patients. Furthermore, reduced LV midwall (but not endocardial) performance is correlated with greater LV mass, clustered in patients with concentric LV hypertrophy and remodeling, and adds independently to LV mass as a predictor of morbidity and mortality. Thus, shifting to easily-assessed LV midwall mechanics reveals prognostically important myocardial dysfunction in many hypertensive patients with superficially 'compensatory' LV hypertrophy.