Analysis of Left Ventricular Systolic Function Using Midwall Mechanics in Patients >60 Years of Age With Hypertensive Heart Disease and Heart Failure

Normal ejection fraction (EFs) is often equated with normal systolic function. However, midwall mechanics reveal systolic dysfunction in hypertensive heart disease accompanied by hypertrophic remodeling. Midwall mechanics are unstudied in patients with acute diastolic heart failure (HF). This study analyzed left ventricular (LV) midwall stress-shortening relations in 61 patients aged >60 years with hypertensive heart disease, HF, and normal EF. Sixty-one hypertensive patients (mean age 78 ± 10 years) who presented with HF, each with an EF >50%, underwent echocardiography. Midwall mechanics were compared with those of 79 controls (mean age 75 ± 8 years) without structural heart disease. Relative wall thickness (0.63 ± 0.11 vs 0.46 ± 0.10 mm) and LV mass (237 ± 67 vs 177 ± 57 g) were significantly greater in patients with HF compared with controls. Mean EFs were similar in patients with HF and controls (64 ± 9% vs 67 ± 9%). Although mean endocardial fractional shortening (35 ± 7% vs 37 ± 7%) was not significantly different, midwall shortening in patients with HF was significantly less compared with controls (16 ± 2% vs 19 ± 3%, p