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(Hypertension. 2001;38:424.)
© 2001 American Heart Association, Inc.

Scientific Contributions

Relationship Between Left Ventricular Diastolic Relaxation and Systolic Function in Hypertension

The Hypertension Genetic Epidemiology Network (HyperGEN) Study

Jonathan N. Bella; Vittorio Palmieri; Jennifer E. Liu; Dalane W. Kitzman; Albert Oberman; Steven C. Hunt; Paul N. Hopkins; D.C. Rao; Donna K. Arnett; Richard B. Devereux

New York Presbyterian Hospital–Weill Cornell Medical Center (J.N.B., V.P., J.E.L., R.B.D.), New York, NY; the Wake Forrest University School of Medicine (D.W.K.), Winston-Salem, NC; the University of Alabama at Birmingham (A.O.); the University of Utah School of Medicine (S.C.H., P.N.H.), Salt Lake City; Washington University (D.C.R.), St. Louis, Mo; and the University of Minnesota (D.K.A.), Minneapolis.

Correspondence to Richard B. Devereux, MD, Division of Cardiology, Box 222, New York Presbyterian Hospital-Weill Cornell Medical Center, 525 East 68th St, New York, NY 10021. E-mail rbdevere{at}med.cornell.edu

Abstract—— The relation of impaired left ventricular relaxation, as measured by prolonged isovolumic relaxation time, to ventricular systolic function in hypertension remains uncertain in population-based samples. In the Hypertension Genetic Epidemiology Network (HyperGEN) Study, echocardiograms were analyzed in 1457 hypertensive participants without diabetes, 2+ valvular regurgitation, or coronary disease. Impaired relaxation (isovolumic relaxation time >100 ms) was present in 219 (15%) of the participants; they were older and had higher arterial pressure than did those with normal relaxation. Ventricular chamber size, wall thicknesses, mass, and relative wall thickness were greater, and stress-corrected midwall shortening and end-systolic stress/end-systolic volume index were lower with impaired relaxation than with normal relaxation time. Fractional shortening and ejection fraction did not differ between the groups. In logistic regression, the likelihood of prolonged isovolumic relaxation time decreased with higher stress-corrected midwall shortening (odds ratio, 0.97%; 95% confidence interval, 0.96 to 0.99), independently of age, heart rate, and ventricular mass. Neither ejection fraction nor the end-systolic stress/end-systolic volume index was independently related to isovolumic relaxation time. In hypertension, impaired left ventricular relaxation parallels ventricular midwall dysfunction but not systolic chamber function. Whether combined diastolic and systolic dysfunction identifies hypertensive patients at especially high risk of cardiovascular events requires further study.

Key Words: hypertension • echocardiography • ventricular function, left • systole • diastole

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