Backgrounds The presence of primary myocardial disease in hypertension, diabetes, and uremia has been anticipated from the evidence of systolic and diastolic left ventricular (LV) dysfunction. Objectives We assessed the hypothesis that myocardial dysfunction in patients with essential hypertension (HT), type 2 diabetes mellitus (DM) and uremia (UR) may be different or summated each other. Methods We consecutively included 729 patients who have HT or DM or UR with left ventricular hypertrophy (LVH). Echocardiographic criteria for LVH were septal and posterior wall thickness above 11mm and LV mass index > 125g/m2. Various myocardial contractile and relaxation echo indices were measured and compared between 4 groups (HT, DM, HT+DM, UR). In UR group, patients who have underlying HT and/or DM and treated by dialysis were included. Results No differences were found in age, sex, body mass index, LV dimension and thickness, EF, diastolic grade, circumferential end-systolic stress (cESS) and LA volume between 4 groups. Among myocardial functional indices, midwall fractional shortening (FSmw), stress corrected FSmw (cFSmw), E' and peak strain in UR were signifcantly decreased compared to HT or DM or HT+DM groups. Especially the value of FSmw, cFSmw, and peak strain were progressively decreased from HT or DM to HT+DM and finally to UR (table). Conclusions Uremic myocardium have more serious dysfunction of contraction and relaxation than hypertensive or diabetic. Myocardial damages from hypertension and diabetes may be summated on myocardium of uremia.

	HT (n=247)	DM (n=184)	HT+DM (n=135)	UR (n=163)
FSmw(%)	16.5짹3.3*	15.4짹3.96*	15.5짹3.2*	14.7짹3.9
cFSmw(%)	73.7짹12.9*	69.9짹14.0*	69.7짹15.2*	67.0짹16.7
S'(cm/s)	8.6짹2.0	8.5짹2.1	8.2짹2.1	8.7짹6.3
E'(cm/s)	7.6짹2.3*	7.0짹4.7	6.4짹2.3#	6.9짹4.1
E/E'	9.8짹4.3	11.7짹5.9	12.8짹6.7#	12.6짹6.3#
peak strain(%)	24.5짹7.2*	26.6짹8.9*	22.7짹9.6*	19.6짹6.8
systolic SR(1/s)	-1.7짹0.6	-1.6짹0.8	-1.5짹0.5	-1.5짹0.4