The relationship between presystolic wave and subclinical left ventricular dysfunction in asymptomatic hypertensive patients Ali R. Akyüz a , Turhan Turan a , İsmail Gürbak b , Levent Korkmaz a , Mustafa T. Ağaç c and Şükrü Çelik a Background The main aim of the current study was to investigate the association between presystolic wave (PSW) and subclinical left ventricular (LV) dysfunction. Patients and methods A total of 139 patients admitted to the cardiology outpatient clinic with hypertension were consecutively enrolled. The patient population included 79 men and 60 women. The presence of a PSW on the left ventricular outflow tract flow was evaluated in all patients. Subclinical LV dysfunction was defined as the presence of a tissue Doppler-derived myocardial performance index (MPI) of at least 0.5 in the absence of impaired left ventricular ejection fraction (< 50%) as evaluated by transthoracic echocardiography. Results The mean age of the patients was 52 ± 10. Patients with PSW had higher MPI (0.44 ± 0.13 vs. 0.37 ± 0.09, P < 0.001), left ventricular mass (LVM) (176 ± 45 vs. 142 ± 33, P < 0.001), and LVM index values (92 ± 23 vs. 76 ± 17, P < 0.001) compared with those without PSW. Patients with PSW had a higher prevalence of subclinical LV dysfunction (29 vs. 3.4%, P: 0.008) and LV hypertrophy (22 vs. 2%, P: 0.011). There was a significant correlation with PSW velocity and age (r = 0.22, P: 0.04), LVM (r = 0.24, P: 0.021), late diastolic mitral annular velocity (r = 0.25, P: 0.018), and an inverse correlation with the E m : A m ratio (r = - 0.34, P: 0.001). Binary logistic regression analysis indicated the presence of PSW (95% confidence interval 1.3–8.031, odds ratio 3.2, P: 0.012) as an independent determinant of abnormal MPI. Conclusion Assessment of presystolic wave on echocardiography was an independent predictor of subclinical LV dysfunction in patients with hypertension. Attention to the PSW on echocardiography examination might help to identify hypertension patients who could be at risk for developing overt heart failure that has a prognostic impact. Blood Press Monit 00:000–000 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. Blood Pressure Monitoring 2016, 00:000–000 Keywords: hypertension, left ventricular dysfunction, left ventricular hypertrophy, presystolic wave a Department of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon, b Department of Cardiology, Osmaniye State Hospital, Osmaniye and c Department of Cardiology, Faculty of Medicine, Sakarya University, Sakarya, Turkey Correspondence to Ali R. Akyüz, MD, Department of Cardiology, Ahi Evren Thoracic and Cardiovascular Surgery Training and Research Hospital, Trabzon 61040, Turkey Tel: + 90 462 2314114; fax: + 90 462 2312420; e-mail: dralirizaakyuz@gmail.com Received 23 February 2016 Revised 5 April 2016 Accepted 18 April 2016 Introduction Hypertension (HT) is one of the most important risk factors for cardiovascular diseases, associated with increased mortality and morbidity [1]. Classic risk scores may underestimate the risk of cardiovascular events in asymptomatic individuals [2]. Longstanding HT gives rise to left ventricular hypertrophy (LVH), which pre- disposes to and exacerbates impairment of left ventricular (LV) function and eventually results in heart failure [3,4]. In patients with arterial hypertension, for identification of patients at high risk of heart failure, it is very important to identify LV dysfunction as early as possible. Myocardial performance index (MPI), first defined by Tei et al. [5], shows both systolic and diastolic functions of the ventricle. MPI has been studied in several cardiac disorders including myocardial infarction, hypertension, diabetes, and heart failure, and increased MPI was shown to be a prognostic index and independent predictor for mortality and morbidity [6,7]. A presystolic wave (PSW) is frequently observed on Doppler examination of the left ventricular outflow tract (LVOT) [8] (Fig. 1). A possible mechanism of PSW is left ventricular stiffness Fig. 1 1.0 15 15:50:11 9 10 5 V 0.5 [m/s] -0.5 -1.0 0 -1 -2 -3 -4 50 mm/s HR -1.5 65 Presystolic wave. The arrow shows the presystolic wave. Original article 1 1359-5237 Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved. DOI: 10.1097/MBP.0000000000000199 Copyright r 2016 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.