Evaluation of Systolic Properties in Hypertensive Patients With Different Degrees of Diastolic Dysfunction and Normal Ejection Fraction

BACKGROUND Left ventricular (LV) diastolic dysfunction (DD) associated with a preserved ejection fraction (EF) is a frequent alteration in hypertensive patients, usually considered an impairment of the diastolic phase alone. However, because systole and diastole are strictly correlated to one another, it is possible that hypertensive patients with isolated DID may also present with initial abnormalities of LV systolic properties, particularly those presenting with a more severe degree of DID. We performed a multiparametric echocardiographic assessment of LV systolic properties in patients without cardiovascular diseases, with preserved EF and different degrees of DID. METHODS We evaluated 1,073 hypertensive subjects showing EF >55% and no overt heart disease. RESULTS A total of 362 patients had normal diastolic function (N), 609 displayed delayed relaxation pattern (DR), and 102 presented a pseudonormal filling pattern (PN). Albeit most of the subjects with DID (DR, PIN) had systolic indexes within normal range, they presented a significant reduction of index stroke volume (SV) (P < 0.0001) and stroke work (SW) (P < 0.0001), EF (P < 0.01), midwall shortening (MFS) (P < 0.0001), circumferential end-systolic stress-corrected MFS (cESS-MFS) (P < 0.001), and tissue Doppler (TD) systolic velocity (P < 0.0001) as compared to the N group, particularly the PN group. After adjustments, the reductions of LV systolic indexes were still significantly related to DID, particularly to PN. CONCLUSIONS Our results suggest a relation between LV systolic and diastolic properties in patients with normal EF. They also highlight the early onset of a preclinical reduction of systolic properties in patients with "isolated" DID, which is related to the degree of dysfunction.