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The main aim of the current study was to investigate the association between presystolic wave (PSW) and subclinical left ventricular (LV) dysfunction.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.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 Em : Am 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.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.