Association of left ventricular longitudinal and circumferential systolic dysfunction with diastolic function in hypertension: a nonlinear analysis focused on the interplay with left ventricular geometry

Background The relationships of left ventricular (LV) longitudinal and circumferential systolic dysfunction with diastolic performance in hypertensive patients have never been compared. Methods and Results In 532 asymptomatic hypertensive patients, circumferential function was assessed with the use of midwall fractional shortening (mFS) and stress-corrected mFS (SCmFS), whereas longitudinal function was assessed with the use of left atrioventricular plane displacement (AVPD) and systolic mitral annulus velocity (s′). Early diastolic annular velocity (e′) and the E/e′ ratio were measured. Global longitudinal and circumferential strain were determined in a subset of 210 patients. e′ was linearly related to all systolic indexes (AVPD: R = 0.40; s′: R = 0.39; mFS: R = 0.16; SCmFS: R = 0.17; all P <.0001), but the correlations were stronger with longitudinal indexes than with circumferential ones (P <.0001). E/e′ was nonlinearly related to AVPD (R = -0.49; P <.0001) and s′ (R = -0.34; P <.0001) and showed no relationship with mFS and SCmFS. Longitudinal indexes were superior to circumferential ones in predicting e′ <8 cm/s, E/e′ <8, and E/e′ ≥13. The effect of LV geometry on LV diastolic function was evident among patients with preserved systolic longitudinal function, but was blunted among patients with impaired longitudinal function. In multivariable analyses, only longitudinal indexes remained associated with e′ and E/e′. Analyses using strains provided similar results. Conclusions In asymptomatic hypertensive subjects, LV diastolic performance is independently associated with longitudinal systolic dysfunction, but not with circumferential systolic dysfunction. Subtle longitudinal systolic impairment plays a role in mediating the effect of LV geometry on diastolic performance. These findings may support the need of critically revising the concept of isolated diastolic dysfunction in these patients.