From the Department of Medicine, The New York Hospital-Cornell Medical
Center, New York, NY.
Correspondence to Richard B. Devereux, MD, Division of Cardiology, Box 222, The New York Hospital-Cornell Medical Center, 525 East 68th St, New York, NY 10021. E-mail rbdevere{at}mail.med.cornell.edu
Abstract—Left
ventricular (LV) midwall shortening (MWS) is subnormal in
relation to LV circumferential end-systolic stress (ESS)
(ESS-corrected MWS) in many hypertensive patients with normal LV
chamber function and predicts subsequent morbidity and mortality.
However, little is known of the relations of LV midwall function to
demographic and metabolic variables or to
arterial geometry. Asymptomatic, unmedicated
normotensive (n=366) or hypertensive (n=282) adults were assessed with
echocardiography and carotid ultrasound. In normal
adults, lower LV MWS and ESS-corrected MWS, an index of LV
contractility, were related independently to high total
peripheral resistance, high heart rate, and male gender
(all P<.00001), lower serum HDL cholesterol
(P=.001) and diastolic pressure
(P=.003), and for ESS-corrected MWS only,
arterial relative wall thickness (RWT,
P=.03). Among hypertensive patients, lower values for
both midwall function indices were associated independently with higher
peripheral resistance (P<.00001), heart
rate (P<.00005), body mass index
(P<.01), and arterial RWT
(P=.04), as well as male gender
(P<.0002). In the entire population, lower LV MWS was
independently related to higher peripheral resistance,
heart rate (both P<.00001), body mass index
(P=.0006) and arterial RWT
(P=.009); male gender (P<.00001); and
lower age (P=.004), diastolic pressure
(P=.042), and systolic carotid artery expansion
(P=.032). Lower ESS-corrected MWS in the entire
population was independently associated with higher
peripheral resistance and heart rate (both
P<.00001), body mass index (P=.0006),
arterial RWT (P=.004); male gender; and
lower diastolic pressure (both P<.00001),
age (P<.00005), arterial expansion in
systole (P=.006), and serum HDL cholesterol
levels (P=.04). Among a subset (n=60), ESS-corrected MWS
was positively related to apolipoprotein A1 (P=.004) and
negatively to hemoglobin A1c (P<.01). Thus, higher LV
midwall function is associated with female gender and more
favorable profiles of hemodynamics,
metabolic pattern, and arterial structure
and function.
© 1998 American Heart Association, Inc.
Scientific Contributions
Relation of Left Ventricular Midwall Function to Cardiovascular Risk Factors and Arterial Structure and Function
Key Words: ultrasonography • cholesterol • contractility • echocardiography • gender • vascular resistance
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