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    Could early septal involvement in the remodeling process be related to the advance hypertensive heart disease?
    (Elsevier Ireland Ltd, 2015) Yalcin, Fatih; Topaloglu, Caner; Kucukler, Nagehan; Ofgeli, Mehmet; Abraham, Theodore P.
    Background: Quantitative imaging analyses showed an earlier septal wall involvement in hypertension. We planned to determine the effect of hypertension on regionalmyocardial performance index (MPI) in a hypertensive patient population. Methods: We evaluated 119 hypertensive patients who were divided into gr. I:57 patients without left ventricular hypertrophy (LVH), (53.1 +/- 10 years), and gr.II:62 patients with LVH (55.1 +/- 9 years) using conventional and tissue doppler imaging. They were compared with gr. III, a sex-age-matched normal control group (37 subjects, 53.0 +/- 10 years). Results: We detected basal septal and basal lateral contraction time (CT), isovolumetric CT and relaxation time (IVRT) and MPI. EF was 68 +/- 5 % in gr. I, 69 +/- 5 % in gr. II, 69 +/- 4 % in gr. III. LV mass index was 122 +/- 11 g/m2 in gr. I, 148 +/- 13 g/m2 in gr. II and 118 +/- 13 g/m2 in gr. III. Concentric LVH was detected in gr. II (relative wall thickness=0.49 +/- 0.8). LV septal and lateral MPI were abnormal in both hypertensive groups (p < 0.0001). Septal MPI was correlated moderately with septal wall thickness (r = 0.447, p < 0.001). Conclusions: LV diastolic dysfunction becomes more severe in septal wall than lateral wall in hypertensive LVH. Septal myocardial performance is more dominantly affected by hypertension possibly due to earlier septal involvement in disease course. Septal MPI is correlated moderately with septal wall thickness. (C) 2015 Published by Elsevier Ireland Ltd.
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    The effect of valsartan on left ventricular myocardial functions in hypertensive patients with left ventricular hypertrophy
    (Lippincott Williams & Wilkins, 2012) Kucukler, Nagehan; Kurt, Ibrahim H.; Topaloglu, Caner; Gurbuz, Suleyman; Yalcin, Fatih
    Background It has been shown by various diagnostic methodologies that angiotensin receptor blockage reduces left ventricular mass, improves diastolic function and increases contractility in hypertensive left ventricular hypertrophy (LVH). We planned to detect the effect of angiotensin receptor blockage on midwall mechanics and myocardial dynamics in hypertensive patients with LVH. Methods Angiotensin 2 type 1 receptor blocker (valsartan 80-160 mg) was administered to 38 previously untreated hypertensive patients with LVH for 6 months. Left ventricular midwall mechanics and tissue Doppler velocities were measured at baseline and at the end of the study. Results: Mean blood pressure was reduced from 152 +/- 14/92 +/- 8 to 131 +/- 14/83 +/- 9 mmHg (P<0.05). Left ventricular mass index was decreased from 135 +/- 15 to 114 +/- 14 g/m(2) (P<0.001). Midwall fractional shortening was increased from 19.0 +/- 4 to 22.4 +/- 3% (P<0.05). Circumferential end-systolic wall stress was decreased from 131 +/- 44 to 119 +/- 37 X 10(3) dyn/cm(2) (P<0.05). Left ventricular interventricular septal myocardial tissue peak systolic velocity was increased from 6.7 +/- 1 to 8.1 +/- 0.9 cm/s (P<0.001) and lateral wall myocardial tissue peak systolic velocity was increased from 7.5 +/- 1 to 9.0 +/- 1 cm/s (P<0.001), and E/E-m ratio was significantly decreased (11.0 +/- 0.3 to 8.90 +/- 0.1, P<0.05) with 6-month valsartan therapy. Conclusion This study suggests that valsartan exhibits not only blood pressure-lowering qualities but also cardioprotective actions in patients with hypertension because it enhances regression of LVH and improves left ventricular myocardial contractility and relaxation.