Letter by Tsilakis et al regarding article "subclinical left ventricular longitudinal systolic dysfunction in hypertension with no evidence of heart failure".

BACKGROUND The prevalence of subclinical left ventricular (LV) systolic dysfunction in asymptomatic hypertensive patients was determined using tissue Doppler imaging (TDI). METHODS AND RESULTS TDI-derived mitral annular velocities were acquired in 35 control subjects, 92 asymptomatic hypertensive patients with no heart failure (HHD), and 15 patients with diastolic heart failure (DHF). No significant intergroup differences in LV ejection fraction were noted. Peak systolic annular velocity was significantly reduced in the DHF group compared with the control and HHD group. Using peak systolic velocity <6.1 cm/s as a cut-off value for abnormal velocity, 10% of HHD patients and 53% of DHF showed impaired LV longitudinal systolic velocity. Peak early diastolic annular velocities were significantly reduced in both the HHD and DHF groups compared with the control group. With multivariable regression analysis, peak early and late diastolic annular velocities, female gender and deceleration time of the E wave velocity were selected as independent predictors for peak systolic annular velocities. CONCLUSIONS Systolic long-axis LV function was impaired in 10% of asymptomatic hypertensive patients. Its reduction was closely correlated with impaired diastolic function. Assessment of LV longitudinal function by TDI plays an important role in identifying diastolic dysfunction and subclinical LV systolic dysfunction in asymptomatic hypertensive patients.