Electrocardiographic strain and endomyocardial radial strain in hypertensive patients.
ABSTRACT Electrocardiographic strain pattern (ECGS) is a well-recognized marker of the presence and severity of anatomic left ventricular hypertrophy (LVH) and also has been associated with adverse prognosis in hypertensive patients. Left ventricular (LV) endomyocardial radial strain (Endo-RS) is predominant in systolic LV wall thickening compared with epimyocardial radial strain (Epi-RS) in a normal heart. However, it remains unclear whether the ratio of Endo-RS to Epi-RS alters in hypertensive patients, especially in those with ECGS.
Endo-RS and Epi-RS in 9 non-hypertensive subjects (Group A), 26 hypertensive subjects without ECGS (Group B), and 16 hypertensive subjects with ECGS (Group C) were assessed by a tissue tracking system.
Relative wall thickness, LV mass index, and voltage of SV1+RV5 were significantly greater in Group C than in both Groups A and B. Although no significant difference was seen in Epi-RS among the 3 groups, Endo-RS and the ratio of Endo-RS to Epi-RS (Endo/Epi-RS) in Group C were significantly lower than those in the other two groups. Multiple logistic regression analysis revealed that the only factor which significantly correlated with Endo/Epi-RS in the first tertile (<1.6) was the presence of ECGS (OR=9.28, p=0.01).
The appearance of ECGS significantly correlated with not only the development of LV hypertrophy but also with the attenuation of Endo-RS.
- [Show abstract] [Hide abstract]
ABSTRACT: Left ventricular hypertrophy, particularly on the electrocardiogram, is an ominous, not an incidental accompaniment of hypertension and cardiovascular disease. The prevalence of electrocardiographic left ventricular hypertrophy increases with age with a slight male predominance, and one in 10 persons aged 30 to 62 can expect to have it within 12 years. At any age, cardiac enlargement on roentgenograms is twice as prevalent as electrocardiographic left ventricular hypertrophy, and in only 16 percent of those with x-ray evidence of cardiac enlargement does electrocardiographic left ventricular hypertrophy subsequently develop. Hypertension predisposes and at systolic pressures exceeding 180 mm Hg evidence of electrocardiographic left ventricular hypertrophy develops in 50 percent, with no closer relation to diastolic, than to systolic pressure. In addition to drastic curtailment of life expectancy, electrocardiographic left ventricular hypertrophy is a harbinger of serious cardiovascular disease. Definite electrocardiographic left ventricular hypertrophy is associated with an eightfold increase in cardiovascular mortality and a sixfold increase in coronary mortality. Electrocardiographic left ventricular hypertrophy with repolarization criteria more than doubles the risk of hypertension alone and carries a greater risk of cardiovascular morbidity and mortality than cardiac enlargement. It identifies hypertensive patients with a compromised coronary circulation and myocardial damage. Risk of stroke, cardiac failure, and every clinical manifestation of coronary heart disease is substantially increased. In those with electrocardiographic left ventricular hypertrophy risk of cardiac failure is three times that in those with hypertension alone. Electrocardiographic left ventricular hypertrophy based solely on voltage criteria reflects chiefly the severity and duration of associated hypertension, carrying only half the cardiovascular risk of electrocardiographic left ventricular hypertrophy with repolarization abnormality. The precise pathologic and anatomic meaning of electrocardiographic left ventricular hypertrophy is unclear in view of the modest correlations with anatomic, x-ray, ventriculographic, and electrocardiographic measures of cardiac hypertrophy. The electrocardiographic aberrations are as much a product of myocardial damage as hypertrophy, and their appearance must be regarded as a grave prognostic sign in the course of cardiovascular disease.The American Journal of Medicine 10/1983; 75(3A):4-11. · 5.30 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: The PRESERVE (Prospective Randomized Enalapril Study Evaluating Regression of Ventricular Enlargement) study is designed to provide a definitive test of the ability of enalapril to achieve greater left ventricular (LV) mass reduction than nifedipine GITs (gastrointestinal treatment system) by a degree that would be prognostically meaningful on a population basis (10 g/m2). To achieve this goal, an ethnically diverse population of 480 men and women with essential hypertension and increased LV mass of screening echocardiography will be enrolled at clinical centers on 4 continents and studied by echocardiography at baseline and after 6 and 12 months' randomized therapy. Blinded readings of echocardiograms at a central laboratory will provide systematic information about treatment effects on LV structure, wall motion, and Doppler blood flow. The study power is at least 90% to test the primary hypotheses that enalapril will induce greater normalization of LV mass and diastolic filling than nifedipine. After the 1-year echocardiographic trial, the study population will be followed 3 more years to test the hypothesis that a reduction in LV mass, independent of blood pressure lowering, is associated with a reduction in the risk of morbid and fatal cardiovascular events.The American Journal of Cardiology 08/1996; 78(1):61-5. · 3.43 Impact Factor
Article: The heart in hypertension.New England Journal of Medicine 11/1992; 327(14):998-1008. · 54.42 Impact Factor