Geometric changes allow normal ejection fraction despite depressed myocardial shortening in hypertensive left ventricular hypertrophy
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Objectives This study of hypertensive left ventricular hypertrophy 1) assessed myocardial shortening in both the circumferential and long-axis planes, and 2) investigated the relation between geometry and systolic function.Background In hypertensive left ventricular hypertrophy, whole-heart studies have suggested normal systolic function on the basis of ejection fraction-systolic stress relations. By contrast, isolated muscle data show that contractility is depressed. It occurred to use that this discrepancy could be related to geometric factors (relative wall thickness).Methods We studied 43 patients with hypertensive left ventricular hypertrophy and normal ejection fraction (mean +/- SD 69 +/- 13%) and 50 clinically normal subjects. By echocardiography, percent myocardial shortening was measured in two orthogonal planes; circumferential shortening was measured at the endocardium and at the midwall, and long-axis shortening was derived from mitral annular motion (apical four-chamber view). Circumferential shortening was related to end-systolic circumferential stress and long-axis shortening to meridional stress.Results Endocardial circumferential shortening was higher than normal (42 +/- 10% vs. 37 +/- 5%, p < 0.01) and midwall circumferential shortening lower than normal in the left ventricular hypertrophy group (18 +/- 3% vs. 21 +/- 3%, p < 0.01). Differences between endocardial and midwall circumferential shortening are directly related to differences in relative wall thickness. Long-axis shortening was also depressed in the left ventricular hypertrophy group (18 +/- 6% in the left ventricular hypertrophy group, 21 +/- 5% in control subjects, p < 0.05). Midwall circumferential shortening and end-systolic circumferential stress relations in the normal group showed the expected inverse relation; those for approximately 33% of the left ventricular hypertrophy group were > 2 SD of normal relations, indicating depressed myocardial function. There was no significant relation between long-axis shortening and meridional stress, indicating that factors other than afterload influence shortening in this plane.Conclusions High relative wall thickness allows preserved ejection fraction and normal circumferential shortening at the endocardium despite depressed myocardial shortening in two orthogonal planes.
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Obese subjects have generally been found to have subclinical contractile abnormalities when assessed with sensitive techniques.
“Indeed, obese subjects have generally been found to have subclinical contractile abnormalities when assessed with the aforementioned techniques (21, 22, 71, 279, 377).”
From Cardiac remodeling in obesity (2008) · cites this paper as [21]
Increased endocardial shortening is a common finding in concentric LVH due to the relatively enhanced excursion of the endocardium in a thick-walled ventricle.
“These results need to be interpreted with caution since increased endocardial shortening is a common finding in concentric LVH due to the relatively enhanced excursion of the endocardium in a thick-walled ventricle (21, 71).”
From Cardiac remodeling in obesity (2008) · cites this paper as [21]
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References 48 · Cited by 399
Research works printed but not linked: 1
- Gaasch WH, Battle WE, Oboler AA, Banas JS, Levine HJ. Left ventricular compliance in man: with special reference to normalized ventricular function curves. Circulation 1972;45:746-62.
- Authors
- Aurigemma, G. P., Silver, K. H., Priest, M. A., & Gaasch, W. H.
- Affiliations
- University of Massachusetts Chan Medical School (US)
- Lahey Hospital and Medical Center (US)
- Corresponding author
- Aurigemma, Gerard P.
- ORCID
- Aurigemma, Gerard P.
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 1995-07
- Volume
- 26
- Issue
- 1
- Pages
- 195-202
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W2106377610
- Cited by
- 399
- References
- 48
- Citations by year
- 2026: 2 · 2025: 5 · 2024: 12 · 2023: 12 · 2022: 8 · 2021: 17 · 2020: 11 · 2019: 16 · 2018: 14 · 2017: 16 · 2016: 19 · 2015: 14 · 2014: 18 · 2013: 15 · 2012: 27
- FWCI
- 3.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiomyopathy and Myosin Studies
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Keywords
- hypertensive left ventricular hypertrophy, myocardial shortening, ejection fraction, relative wall thickness, circumferential shortening, meridional stress, cardiac contractility, left ventricular geometry, systolic function
- MeSH terms
- Adult, Aged, Aged, 80 and over, Echocardiography, Endocardium, Female, Humans, Hypertension, Male, Middle Aged, Myocardial Contraction, Stroke Volume, Case-Control Studies, Hypertrophy, Left Ventricular
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