Abnormal left ventricular longitudinal function assessed by echocardiographic and tissue Doppler imaging is a powerful predictor of diastolic dysfunction in hypertensive patients: The SPHERE study

Background Through integrated use of echo-Doppler and tissue Doppler imaging (TDI), it is possible to obtain a comprehensive evaluation of both left ventricular (LV) diastolic and longitudinal functions. In this study, we sought to assess the prevalence of LV diastolic dysfunction (LVDD) and its relation with indices of long-axis function in asymptomatic patients with arterial hypertension. Methods and results A perspective echo-Doppler study was performed in 1556 consecutive asymptomatic patients with grade 2-to-3 arterial hypertension aged 40-80 years enrolled in the SPHERE (multicenter proSPective study of ecHocardiography in hypERtEnsion) study. All patients had a LV ejection fraction (EF) ≥ 50% and no history of heart failure or coronary artery disease. Advanced LVDD was identified by an average mitral-to-peak early diastolic annular ratio (E/e′) ≥ 13. Less than advanced LVDD was identified by: 8 < E/e′ < 13 and left atrial volume index ≥ 34 ml/m². Overall LVDD was present in 286 patients (18%): advanced in 128, less than advanced in 158. LV long-axis function, as assessed by average peak systolic annular velocity (hazard ratio [HR]: 0.54, p < 0.0001), mitral E/A ratio (HR: 3.20, p = 0.0009), age (HR: 1.05, p = 0.0087), body mass index (HR: 1.06, p = 0.037), and relative wall thickness (HR: 1.05, p = 0.050) were independent predictors of advanced LVDD. LV long-axis function (HR: 0.78, p < 0.0001), E/A ratio (HR: 2.35, p = 0.0032), LV end-diastolic volume index (HR: 1.04, p = 0.0035), and age (HR: 1.03, p = 0.018) were independently associated with overall LVDD, with a borderline contribution of LV mass index (HR: 1.01, p = 0.062). Conclusions An abnormal LV long-axis function was a powerful determinant of any LVDD in asymptomatic patients with arterial hypertension.