Skip to main content
SpringerLink
Log in

Layer-specific dyssynchrony and its relationship to the change of left ventricular function in hypertensive patients

  • Original Article
  • Published:
Heart and Vessels Aims and scope Submit manuscript

Abstract

Left ventricular (LV) remodeling in systemic arterial hypertension causes electrical conduction delay and impairs synchronous contraction, which may contribute to the development of heart failure. This study aimed to assess the change of LV mechanics in hypertension by layer-specific dyssynchrony. One hundred and twenty-one patients with primary hypertension and LV ejection fraction >50 % (mean age, 62 ± 10 years) and 31 normotensive controls (mean age, 63 ± 9 years) were prospectively included. Layer-specific dyssynchrony index (DI) was defined as standard deviation of time interval (TI) from the onset of Q wave to peak longitudinal strain obtained from 18 segments in each endocardial, myocardial, and epicardial layer. The global TI between the onset of Q wave to peak global longitudinal strain in each layer was obtained and the time difference (TD) of global TI between layers was calculated. DIs were significantly different in three layers (P < 0.001 in both groups), and were significantly greater in hypertensive patients than in controls except epicardial DI. End diastolic filling pressure and LV global longitudinal strain were related with endocardial DI. TD between endocardium and myocardium was greater in hypertensive patients than in controls (P = 0.001). Layer-specific DI revealed delayed contraction in each layer and between layers in hypertensive patients, which were apparent in endocardium and between endocardium and myocardium. Increased layer-specific DIs were associated with subclinical LV dysfunction, although LV ejection fraction was preserved. These may be helpful to understand layer-specific mechanical property of LV myocardium and for early detection of subclinical impairment of myocardial function.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Spragg DD, Kass DA (2006) Pathobiology of left ventricular dyssynchrony and resynchronization. Prog Cardiovasc Dis 49:26–41

    Article  PubMed  Google Scholar 

  2. Yang B, Chettiveettil D, Jones F, Aguero M, Lewis JF (2008) Left ventricular dyssynchrony in hypertensive patients without congestive heart failure. Clin Cardiol 31:597–601

    Article  PubMed  Google Scholar 

  3. Lip GY, Felmeden DC, Li-Saw-Hee FL, Beevers DG (2000) Hypertensive heart disease. A complex syndrome or a hypertensive ‘cardiomyopathy’? Eur Heart J 21:1653–1665

    Article  CAS  PubMed  Google Scholar 

  4. Berk BC, Fujiwara K, Lehoux S (2007) ECM remodeling in hypertensive heart disease. J Clin Invest 117:568–575

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Opthof T, Coronel R, Janse MJ (2009) Is there a significant transmural gradient in repolarization time in the intact heart? Repolarization gradients in the intact heart. Circ Arrhythm Electrophysiol 2:89–96

    Article  PubMed  Google Scholar 

  6. Rohr S (2009) Myofibroblasts in diseased hearts: new players in cardiac arrhythmias? Heart Rhythm 6:848–856

    Article  PubMed  Google Scholar 

  7. Okin PM, Devereux RB, Kjeldsen SE, Edelman JM, Dahlof B (2009) Incidence of heart failure in relation to QRS duration during antihypertensive therapy: the LIFE study. J Hypertens 27:2271–2277

    Article  CAS  PubMed  Google Scholar 

  8. Chang SA, Kim HK, Kim DH, Kim YJ, Sohn DW, Oh BH, Park YB (2009) Left ventricular systolic and diastolic dyssynchrony in asymptomatic hypertensive patients. J Am Soc Echocardiogr 22:337–342

    Article  PubMed  Google Scholar 

  9. Kwon BJ, Jang SW, Choi KY, Kim DB, Cho EJ, Ihm SH, Youn HJ, Rho TH, Kim JH (2012) Impact of antihypertensive treatment on left ventricular systolic dyssynchrony in treatment-naive hypertensive patients. Hypertens Res 35:661–666

    Article  CAS  PubMed  Google Scholar 

  10. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ, Chamber Quantification Writing Group, American Society of Echocardiography’s Guidelines and Standards Committee, European Association of Echocardiography (2005) Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr 18:1440–1463

    Article  PubMed  Google Scholar 

  11. Pirat B, Khoury DS, Hartley CJ, Tiller L, Rao L, Schulz DG, Nagueh SF, Zoghbi WA (2008) A novel feature-tracking echocardiographic method for the quantitation of regional myocardial function: validation in an animal model of ischemia-reperfusion. J Am Coll Cardiol 51:651–659

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kleber AG, Rudy Y (2004) Basic mechanisms of cardiac impulse propagation and associated arrhythmias. Physiol Rev 84:431–488

    Article  CAS  PubMed  Google Scholar 

  13. Mayet J, Hughes A (2003) Cardiac and vascular pathophysiology in hypertension. Heart 89:1104–1109

    Article  PubMed  PubMed Central  Google Scholar 

  14. de Bakker JM, van Rijen HM (2006) Continuous and discontinuous propagation in heart muscle. J Cardiovasc Electrophysiol 17:567–573

    Article  PubMed  Google Scholar 

  15. Tsamis A, Bothe W, Kvitting JP, Swanson JC, Miller DC, Kuhl E (2011) Active contraction of cardiac muscle: in vivo characterization of mechanical activation sequences in the beating heart. J Mech Behav Biomed Mater 4:1167–1176

    Article  PubMed  PubMed Central  Google Scholar 

  16. Fujiwara S, Komamura K, Nakabo A, Masaki M, Fukui M, Sugahara M, Itohara K, Soyama Y, Goda A, Hirotani S, Mano T, Masuyama T (2014) The association between left ventricular twisting motion and mechanical dyssynchrony: a three-dimensional speckle tracking study. Heart Vessels. doi:10.1007/s00380-014-0586-4

    Google Scholar 

  17. Kwon BJ, Jang SW, Choi KY, Lee JB, Kim DB, Cho EJ, Ihm SH, Youn HJ, Rho TH, Kim JH (2013) Independent determinants for presence and degree of left ventricular systolic dyssynchrony in treatment-naive patients with hypertension. J Hypertens 31:601–609 (discussion 609)

    Article  CAS  PubMed  Google Scholar 

  18. Nakamura N, Hirata K, Imanishi T, Kuroi A, Arita Y, Ikejima H, Tsujioka H, Takemoto K, Tanimoto T, Kitabata H, Takarada S, Kubo T, Mizukoshi M, Tanaka A, Arita M, Akasaka T (2011) Electrocardiographic strain and endomyocardial radial strain in hypertensive patients. Int J Cardiol 150:319–324

    Article  PubMed  Google Scholar 

  19. Sanderson JE (2007) Heart failure with a normal ejection fraction. Heart 93:155–158

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgments

We sincerely thank Jeong-Hyang Kim and Young-Woon Choi for obtaining images and collecting data. This study was supported by a Korea University Grant (Park SM).

Conflict of interest

None declared.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 126-1, Anam-dong 5 ga, Seongbuk-gu, Seoul, 136-705, Republic of Korea

    Su-A Kim, Mi-Na Kim, Wan-Joo Shim & Seong-Mi Park

Authors
  1. Su-A Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mi-Na Kim
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Wan-Joo Shim
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Seong-Mi Park
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Seong-Mi Park.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kim, SA., Kim, MN., Shim, WJ. et al. Layer-specific dyssynchrony and its relationship to the change of left ventricular function in hypertensive patients. Heart Vessels 31, 528–534 (2016). https://doi.org/10.1007/s00380-014-0626-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00380-014-0626-0

Keywords

Search

Navigation