Left Ventricular Systolic Function Indexes by Echocardiography in Hypertensive Subjects

Seong Sik Sohn; Suck Hwan Kim; Jin Won Jeong; Yang Kyu Park; Ock Kyu Park

doi:10.3803/jkes.1996.4.1.57

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Sohn, Kim, Jeong, Park, and Park: Left Ventricular Systolic Function Indexes by Echocardiography in Hypertensive Subjects

Original Article

J Korean Soc Echocardiogr 1996;4(1):57-65.

Published online: 18 February 1996

DOI: https://doi.org/10.3803/jkes.1996.4.1.57

Left Ventricular Systolic Function Indexes by Echocardiography in Hypertensive Subjects

Seong Sik Sohn, M.D., Suck Hwan Kim, M.D., Jin Won Jeong, M.D., Yang Kyu Park, M.D., Ock Kyu Park, M.D.

Deptartment of Internal Medicine, WonKwang University Hospital, Iksan, Korea

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

The evaluation of cardiac performance is very important to management and prognostication in hypertensive patients. Although ejection phase indexes have been used for assessing left ventricular systolic function they are highly dependent on cardiac loading conditions. In addition, these load-dependent indexes may not differentiate accurately between the effects of altered loading conditions and intrinsic abnormalities in contractile function of cardiac muscle. In recent years, the end-systolic pressure to volume or dimension relations have emerged as a reliable measure of the myocardial contractility. The authors studied the changes of end-systolic pressure to volume or dimension relations according to pre-load and after-load by using the Echocardiogrom.

Methods

By 2-D and M-mode Echocardiogram we measured the ratio of end-systolic wall sress to end-systolic volume index(EWS/ESVI), peak systolic pressure to end-systolic dimension of left ventricle(PSP/ESD), peak systolic pressure to end-systolic volume index(PSP/ESVI) to assess myocardial contractility in 139 normal subjects and 55 patients with untreated essential hypertension. Then we compare these indexes to systemic blood pressure & left ventriclular end-diastolic dimension.

Results

1) EF, %FS, and mVcf were similar in both groups, but PSP/ESD, PSP/ESVI, EWS/ESVI tor the hypertensive group were greater than that for the normal group.

2) There was poor relation between arterial blood pressure and EWS/ESVI than other load-independent indexes in both groups.

3) There was poor relation between left ventricle end diastolic dimension than other load-independent indexes in both groups.

Conclusion

The ratio of end-systolic wall stress to end-systolic volume index(EWS/ESVI) is a reliable load independent index to assess myocardial contractility in hypertension.

Keywords: Myocardial contractility, Load independent index.

References

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Fig. 1.

Relations of SBP to (A) PSP/ESD (r=0.65) (B) PSP/ESVI (r=0.41), (C) EWS/ESVI (r=0.17) in normal subjects. SBP: Systolic blood pressure PSP: Peak systolic blood pressure ESD: Left ventricular end-systolic dimension ESVI: Left ventricular end systolic volume index EWS: Left ventricle end systolic wall stress.

Fig. 2.

Relations of SBP to (A) PSP/ESD (r=0.32) (B) PSP/ESVI (r=0.06), (C) EWS/ESVI (r=0.002) in hypertensive subjects. SBP: Systolic blood pressure PSP: Peak systolic blood pressure ESD: Left ventricular end-systolic dimension ESVI: Left ventricular end systolic volume index EWS: Left ventricle end systolic wall stress.

Fig. 3.

Relations of EDD to (A) PSP/ESD (r=–0.55) (B) PSP/ESVI (r=0.56), (C) EWS/ESVI (r=–0.40) in normal subjects. EDD: Left ventricular end-diastolic dimension, PSP: Peak systolic blood pressure ESD: Left ventricular end-systolic dimension ESVI: Left ventricular end systolic volume index EWS: Left ventricle end systolic wall stress.

Fig. 4.

Relations of EDD to (A) PSP/ESD (r= −0.657) (B) PSP/ESVI (r=–0.68), (C) EWS/ESVI (r=–0.30) in hypertensive subjects. EDD: Left ventricular end-diastolic dimension, PSP: Peak systolic blood pressure ESD: Left ventricular end-systolic dimension ESVI: Left ventricular end systolic volume index EWS: Left ventricle end systolic wall stress.

Table 1.

Calculation Formula

Table 2.

Characteristics of Normal and Hypertensive subjects

	Normal(n=139)	Hypertension (= 55)	P value
Age (yrs)	42 ± 14	58 ± 14	.0001
Height(cm)	164 ± 8	159 ± 9	.0001
Weight(Kg)	63 ± 10	65 ± 12	NS
BMI(kg/m²)	23 ± 3	26 ± 4	.0001
LVMI(g/Ht)	105 ± 22	149 ± 53	.0001
EDD(mm)	52 ± 4	49 ± 4	.0002
ESD(mm)	32 ± 4	30 ± 5	.004
IVSd(mm)	9 ± 1	13 ± 3	.0001
IVSs(mm)	13 ± 2	17 ± 4	.0001
LVPWd(mm)	9 ± 1	12 ± 3	.0001
LVPWs(mm)	14 ± 2	17 ± 3	.0001
EWS (10³dynes/cm²)	47 ± 12	47 ± 19	NS
PWS (10³ynes/cm²)	141 ± 35	124 40	.003
ESVI(ml/m²)	24 ± 8	23 ± 9	NS

BMI: Body mass index LVMI: Left ventricular mass index Ht: Height ESD: Left ventricular end-systolic dimension EDD: Left ventricular end-diastolic dimension IVSd: End-diastolic interventricular septal thickness IVSs: End-systolic interventricular septal thickness LVPWd: End-diastolic left ventricular posterior wall thickness LVPWs: End-systolic left ventricular posterior wall thickness EWS: Left ventricle end systolic wall stress PWS: Left ventricle peak systolic wall stress ESVI: Left ventricle end systolic volume index

Table 3.

Left ventricular contractile function indexes in normal and hypertensive subjects

	Normal(n = 139)	Hypertension (n = 55)	P value
EF(%)	69 ± 6	69 ± 8	NS
% Fs	39 ± 6	40 ± 7	NS
mVcf(cic/s)	1.3 ± 0.2	1.4 ± 0.3	NS
PSP/LVDs	3.7 ± 6	5.4 ± 10	.0001
PSP/ESVI	5.2 ± 1.6	7.6 ± 3.4	.0001
EWS/ESVI	2.0 ± 0.5	2.2 ± 0.7	.0009

EF: Ejection fraction %FS: Percent of fractional shortening mVcf: Mean velocity of circumferential fiber shortening PSP: Peak systolic blood pressure ESD: Left ventricular end-systolic dimentsion ESVI: Left ventricular end systolic volume index EWS: Left ventricle end systolic wall stress

Table 4.

Correlation between blood pressure with contractile function indexes in normal and hypertensive subjects

		Normal(n = 139)	Hypertension (n = 55)
SBP	PSP/ESD	0.65	0.32
	PSP/ESVI	0.41	0.06
	EWS/ESVI	0.17	0.002
DBP	PSP/ESD	0.53	0.04
	PSP/ESVI	0.37	–0.04
	EWS/ESVI	0.10	0.09
MBP	PSP/ESD	0.62	0.23
	PSP/ESVI	0.40	0.02
	EWS/ESVI	0.14	0.04

SBP: Systolic blood pressure DBP: Diastolic blood pressure MBP: Mean blood pressure PSP: Peak systolic blood pressure ESD: Left ventricular end systolic dimension ESVI: Left ventricle end systolic volume index EWS: Left ventricle end systolic wall stress

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