1),2) Thus, ventricular systolic and diastolic stiffness linked to the interaction between the heart and vascular loads are affected by intrinsic changes in the ventricular myocardium.3) Coupled ventricular-arterial stiffening may have a potent impact on limited systolic and diastolic reserve, blood pressure lability, coronary and peripheral flow regulation, and cardiac metabolic demand under stress. Although these adverse effects are thought to play a role in the pathophysiology of heart
failure in patients with normal ejection fraction (EF),4) the mechanism by which chronic ventricular-arterial stiffening alters regional myocardial function remains unclear. The speckle tracking method has overcome several limitations Inhibitors,research,lifescience,medical Inhibitors,research,lifescience,medical of tissue Doppler imaging in terms of, tethering effect, translation movement and angle dependency. Thus, speckle tracking can provide useful information on three-dimensional myocardial deformations and cardiac torsion.5),6) Using aortic pulse wave velocity (PWV) and speckle tracking echocardiography, we have evaluated the impact of chronic arterial stiffening, on the early changes in systolic and diastolic function Inhibitors,research,lifescience,medical of the regional myocardium, in hypertensive patients with normal EF. Methods Study population We evaluated 70 consecutive patients
with untreated hypertension (repeated systolic blood pressure > 140 mmHg and/or diastolic blood pressure > 90 mmHg), who visited the outpatient clinic for the management Inhibitors,research,lifescience,medical of hypertension. None of these patients had received anti-hypertensive medications. All patients showed a normal EF (> 55%), as assessed by two-dimensional transthoracic echocardiography, and a normal sinus rhythm on electrocardiography. We excluded patients with positive exercise stress test, myocardial ischemia
on thallium scan, PD-1/PD-L1 inhibitor 2 presence of regional wall motion abnormality on echocardiography and significant coronary artery stenosis (diameter stenosis > 50%) on coronary angiography Inhibitors,research,lifescience,medical or coronary computed tomography. Patients with any evidence of secondary hypertension, diabetes mellitus, valvular heart disease, liver disease or systemic inflammatory disease were also excluded. Conventional echocardiographic measurements Before starting anti-hypertensive medication, Carnitine dehydrogenase each patient underwent two-dimensional, M-mode and Doppler echocardiography using commercially available equipment (VIVID 7 machine, GE-Vingmed Ultrasound, Horten, Norway). The LV diameter of end-diastole (LVIDd) and end-systole, end-diastolic thickness of the ventricular septum (SWTd) and LV posterior wall (PWTd) were measured by M-mode echocardiography. LV mass and relative wall thickness was derived from ASE-recommended formula.7) LV mass = 0.8 × 1.04 × [(LVIDd + PWTd + SWTd)3 - (LVIDd)3] + 0.6 g Relative wall thickness = (2 × PWTd) / LVIDd LV mass index was determined by dividing the LV mass by the body surface area.