Circulation, Vol 89, 122-131, Copyright © 1994 by American Heart Association
LC Palmon, N Reichek, SB Yeon, NR Clark, D Brownson, E Hoffman and L Axel
BACKGROUND: In hypertensive left ventricular hypertrophy (LVH), intrinsic
myocardial systolic function may be normal or depressed. Magnetic resonance
tagging can depict intramural myocardial shortening in vivo. METHODS AND
RESULTS: Tagged left ventricular magnetic resonance images were obtained in
30 hypertensive subjects with LVH (mean LV mass index, 142 +/- 41 g/m) and
normal ejection fraction (mean, 64 +/- 9%) using spatial modulation of
magnetization. In 26 subjects, circumferential myocardial shortening (%S)
was compared with results obtained in 10 normal subjects at endocardium,
midwall, and epicardium on up to 4 short-axis slices each. Similarly, in 10
subjects, midwall long-axis shortening at basal, midventricular, and apical
sites was compared with results obtained in 12 normal volunteers.
Circumferential %S was reduced in hypertensive subjects. Mean shortening
was 29 +/- 6% at the endocardium in hypertensive subjects versus 44 +/- 6%
in normal subjects (P = .0001); 20 +/- 6% at the midwall versus 30 +/- 6%
(P = .0001); and 13 +/- 5% at the epicardium versus 21 +/- 5% (P = .0002).
However, the transmural gradient in percent shortening from endocardium to
epicardium in hypertensive subjects paralleled that in normal subjects. The
normal base-to-apex gradient in circumferential %S was absent in LVH. In
contrast to normal subjects, circumferential %S showed regional
heterogeneity in hypertensive subjects, being maximal in the lateral wall
and least in the inferior wall. Longitudinal shortening was also uniformly
depressed in hypertensive subjects: 10 +/- 9% at the base versus 21 +/- 6%
in normal subjects (P = .0001); 14 +/- 8% at the midventricle versus 18 +/-
3% (P = .03); and 14 +/- 8% at the apex versus 18 +/- 4% (P = .04).
CONCLUSIONS: In hypertensive LVH with normal pump function, intramural
circumferential and longitudinal myocardial shortening are depressed.
ARTICLES
Intramural myocardial shortening in hypertensive left ventricular hypertrophy with normal pump function
Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia.
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