LEFT VENTRICULAR MIDWALL FRACTIONAL SHORTENING: ITS RELATIONSHIP WITH THE DIASTOLIC FUNCTION ANALYZED BY DOPPLER ECHOCARDIOGRAPHY AND TISSUE DOPPLER IN HYPERTENSIVE PATIENTS
Authors: Alvarez R. , Mollon P. , Monaco R. , Villa D. , Puglia. D. 
Published: February 2004

Objective: To analyze the existence of association between the left ventricular myocardial systolic function evaluated by midwall fractional shortening (MFs) and the behavior of left ventricular diastolic function evaluated by the E/A ratio in asymtomatic hypertensive treated patients, using Doppler echocardiography and the pulsed tissue Doppler.

Methods: A population of 45 mild‐to‐moderate hypertensive patients (34 men and 11 women) with treatment and average age 47 ± 9, years were studied. Clinical examination, electrocardiogram, Doppler echocardiography, and pulsed tissue Doppler in rest were performed on all of the patients. The following variables were taken into account: height, weight, body surface (BS), body mass index (BMI), heart rate (HR), systolic and diastolic blood pressure (SBP, DBP), left ventricular dimensions and thicknesses (LVIDd, LVIDs, IVSDd, IVSDs, PWTd and PWTs, endocardial fractional shortening (EFs), ejection fraction (EF), relative wall thickness (RWT), left ventricular mass (LVM), left ventricular mass index (LVMI), systolic volume (SV), systolic volume index (SVI), circumferential end‐systolic wall stress (CESS), left atrial dimension (LAD), E(E) and A (A) peak velocity waves of diastolic filling, E/A ratio (E/A), deceleration time (DT), isovolumic relaxation time (IVRT), A wave duration(AD), E tisular (Et), A tisular (At), S tisular (St) peak velocity waves and Et/At ratio. The total population was separated into two groups: G1 formed by 27 (60%) patients with normal MFs (>19%) and G2 formed by 18 (40%) patients with diminished MFs (<19%). By means of the Student's t‐test, the means of variables of both groups were compared. Using the chi‐squared independence test for qualitative variables and the test of diferences for two proporcions, the relation existing between the MFs and the E/A and Et/At of G1 and G2 were analyzed, taking as normal value when it is >1 and abnormal value when it is <1 in both variables. The p value was considered significantly at <0.05.

Results: The G1 (MFs > 19%) showed values significantly higher in EFs, EF, SV, SVI, E and E/A, and significantly lower values in A (p < 0.05). The rest of the studied variables did not show significant differences. A comparison of the MFs with E/A and Et/At by means of the chi‐squared test showed a significant dependence relation (p < 0.05). The analysis of the proportions showed that 89% of the patients with diminished MF (>19%) had a E/A <1 (p < 0.05) and 72% of the same group had a Et/At <1 (p < 0.05).

Conclusion: In studied hypertensive patients, a MFs normal (>19%) was associated with a better left ventricular endocardial systolic function and with a better diastolic function evaluated by means of the E, A, and E/A of the ventricular filling. A significant dependence relation exists between la MFs and the diastolic function. Most of the hypertensive patients with diminished MFs show a worsening of the diastolic function evaluated by the E/A ratio of ventricular filling as well as the Et/At ratio of the pulse tissue Doppler.