Left ventricular systolic synchrony of patients with hypertensive heart failure but preserved ejection fraction and its impact on left ventricular function

Abstract

Objective To investigate the systolic synchrony of the left ventricle in patients with left ventricular hypertrophy (LVH) or with heart failure but preserved ejection fraction (HF-PEF), and to evaluate the impact of systolic dyssynchrony on left ventricular function. Methods During June 2011 to May 2014, a total of 352 patients(160 males, 192 females, average age: (67.6±7.8)years) with essential hypertension (EH) were enrolled in this retrospective study. Ultrasonic and G-MPI were performed for assessment of left ventricular remodeling and systolic synchrony and the results were statistically analyzed by one-way analysis of variance and χ2 test. Relationship between BNP and synchronic parameters as well as other clinical factors were analyzed by partial correlation analysis. Results The EH patients were divided into hypertension group (n=182), LVH group (n=74) and HF-PEF group (n=96). In comparison to hypertension group, significant LVH developed in LVH and HF-PEF groups although the LVEF was still preserved. The LVMI of the 3 groups were (94.4±10.1), (121.1±9.8) and (123.2±10.9) g/m2, respectively(F=8.66, P 0.05). Diastolic dysfunction was identified in LVH and HF-PEF groups with significantly reduced E/A ratio (1.19±0.23, 0.80±0.28, 0.67±0.17; F=13.46, P<0.05). Remarkable left ventricular systolic dyssynchrony with phase histogram bandwidth (PHB) of (88.4±8.6)° and phase standard deviation (PSD) of (23.6±1.9)° and increased BNP of (228.4±69.7) ng/L were revealed in HF-PEF group. The BNP in HF-PEF group was significantly higher than that in LVH group((92.5±13.6) ng/L; q=8.63, P<0.05). Positive correlation was found between BNP level and PHB, PSD, LVMI, respectively (r=0.277-0.331, all P<0.05). Conclusion Left ventricular systolic dyssynchrony is concomitant with HF-PEF patients induced by EH, and this dyssynchrony might be one of the factors leading to diastolic dysfunction. Key words: Heart failure; Hypertension; Stroke volume; Tomography, emission-computed, single-photon; Ultrasonography; MIBI