Abnormal Left Ventricular Relaxation in Hypertensive Patients

Fouad, Fetnat M.; Tarazi, Robert C.; Gallagher, Joe H.; MacIntyre, William J.; Cook, Sebastian A.

doi:10.1042/cs059411s

Cited by 128 publications

(34 citation statements)

References 15 publications

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“…In comparison with Doppler-derived indices of diastolic filling, the videodensitometric parameters showed a significantly higher ability to discriminate between hypertensive subjects and normal controls. [1][2][3][4][5][6] Some experimental 7-10 and autopsy 11-14 data support the hypothesis that arterial hypertension per se could contribute to both an increase in intramyocardial fibrosis and an alteration in the microcirculatory system. A quantitative analysis of the 2-dimensional spatial pattern or the "texture" of the echocardiographic images represents a useful approach that allows ultrasound myocardial tissue characterization (quantitative texture analysis).…”

supporting

confidence: 59%

“…[1][2][3][4][5][6] Some experimental [7][8][9][10] and autopsy [11][12][13][14] data support the hypothesis that arterial hypertension per se could contribute to both an increase in intramyocardial fibrosis and an alteration in the microcirculatory system. A quantitative analysis of the 2-dimensional spatial pattern or the "texture" of the echocardiographic images represents a useful approach that allows ultrasound myocardial tissue characterization (quantitative texture analysis).…”

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confidence: 55%

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Ultrasonic Myocardial Texture Versus Doppler Analysis in Hypertensive Heart

et al. 1999

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Abstract-Doppler-derived parameters of transmitral flow are useful indices of diastolic dysfunction in the hypertensive heart. Different degrees of myocardial involvement in hypertensive heart can be detected by videodensitometric myocardial textural analysis. The aim of this study was to compare Doppler-derived and ultrasonic videodensitometric parameters in the differentiation of healthy hearts from hypertensive hearts. We compared a group of age-matched (59Ϯ9 years) male essential hypertensive patients (nϭ53) with normotensive healthy subjects as controls (nϭ32). All subjects provided ambulatory blood pressure measurements for the evaluation of 24-hour mean systolic and diastolic blood pressure. A transmitral flow Doppler analysis was performed on all subjects. A quantitative analysis of the echocardiographic digitized imaging was performed with the help of a calibrated digitization system to calculate the septum and the posterior wall textural parameters. The myocardial mean gray level (MGL) was calculated to derive the cyclic variation index (CVI): (MGL end-diastolic ϪMGL end-systolic )/MGL end-diastolic ϫ100. When compared with controls, the hypertensive patients showed a significantly lower CVI for both septum (Ϫ11.1Ϯ26.8% versus 34.7Ϯ16.3%; PϽ0.001) and posterior wall (Ϫ11.2Ϯ27.6% versus 38.2Ϯ15.4%; PϽ0.001). Individual analyses for the ratio of peak transmitral flow velocity in early diastole to the peak transmitral flow velocity in late diastole showed that only 24% of the patients (13/53) were discriminated from normal subjects by this parameter. Individual analyses for CVI, however, at both septum and posterior wall levels, showed that 74% of the patients (39/53) were discriminated from normal subjects by this second parameter. In comparison with Doppler-derived indices of diastolic filling, the videodensitometric parameters showed a significantly higher ability to discriminate between hypertensive subjects and normal controls. [1][2][3][4][5][6] Some experimental 7-10 and autopsy 11-14 data support the hypothesis that arterial hypertension per se could contribute to both an increase in intramyocardial fibrosis and an alteration in the microcirculatory system. A quantitative analysis of the 2-dimensional spatial pattern or the "texture" of the echocardiographic images represents a useful approach that allows ultrasound myocardial tissue characterization (quantitative texture analysis). This technique was effective in the identification of acutely ischemic and contused myocardium in animal models. 15,16 It was also applied to humans for the identification of amyloid 17 and hypertrophic cardiomyopathies, 18 myocarditis, 19 myocardial ischemia, 20 viable myocardium, 21 and severe LVH in hypertension. 22 The aims of our study were (1) the evaluation of myocardial texture through analysis of the first-order gray level in a group of agematched hypertensive patients compared with normotensive subjects and (2) the evaluation of the power to discriminate between hypertensive and normal hearts of both pulsed ...

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confidence: 59%

supporting

confidence: 55%

Ultrasonic Myocardial Texture Versus Doppler Analysis in Hypertensive Heart

et al. 1999

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“…1 Early detection of changes in cardiac performance, before irreversible damage to the heart has occurred, can contribute substantially to a further decline in hypertension-related death. 1 Previous echocardiographic and radionuclide studies have shown impaired diastolic heart function in hypertension, even in the absence of left ventricular (LV) hypertrophy (LVH), [2][3][4][5][6][7][8] whereas systolic function is still preserved. [2][3][4]7,8 Animal studies have shown that myocardial high-energy phosphate (HEP) metabolism is altered in hypertensive heart disease, in particular when LV mass is increased.…”

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confidence: 99%

Diastolic Dysfunction in Hypertensive Heart Disease Is Associated With Altered Myocardial Metabolism

et al. 1999

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Background-Hypertension is an important clinical problem and is often accompanied by left ventricular (LV) hypertrophy and dysfunction. Whether the myocardial high-energy phosphate (HEP) metabolism is altered in human hypertensive heart disease and whether this is associated with LV dysfunction is not known. Methods and Results-Eleven patients with hypertension and 13 age-matched healthy subjects were studied with magnetic resonance imaging at rest and with phosphorus-31 magnetic resonance spectroscopy at rest and during high-dose atropine-dobutamine stress. Hypertensive patients showed higher LV mass (98Ϯ28 g/m 2 ) than healthy control subjects (73Ϯ13 g/m 2 , PϽ0.01). LV filling was impaired in patients, reflected by a decreased peak rate of wall thinning (PRWThn), E/A ratio, early peak filling rate, and early deceleration peak (all PϽ0.05), whereas systolic function was still normal. The myocardial phosphocreatine (PCr)/ATP ratio determined in patients at rest (1.20Ϯ0.18) and during stress (0.95Ϯ0.25) was lower than corresponding values obtained from healthy control subjects at rest (1.39Ϯ0.17, PϽ0.05) and during stress (1.16Ϯ0.18, PϽ0.05). The PCr/ATP ratio correlated significantly with PRWThn (rϭϪ0.55, PϽ0.01), early deceleration peak (rϭϪ0.56, PϽ0.01), and with the rate-pressure product (rϭϪ0.53, PϽ0.001). Conclusions-Myocardial HEP metabolism is altered in patients with hypertensive heart disease. In addition, there is an association between impaired LV diastolic function and altered myocardial HEP metabolism in humans.

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“…Impaired left ventricular diastolic filling at rest is also a common finding in patients with hypertension, especially in those with ventricular hypertrophy, even in the absence of evidence of decreased systolic performance. [6][7][8][9] The relation between ventricular diastolic filling and the maintenance of adequate systolic function during exercise has not been addressed. As systolic tension development and ejection performance of the left ventricle depends to a large degree on completeness of relaxation and adequate diastolic filling, we hypothesized that impaired left ventricular filling in patients with hypertension might predispose to the reduced systolic functional reserve observed in many patients during exercise.…”

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Left ventricular hypertrophy and impaired diastolic filling in essential hypertension. Diastolic mechanisms for systolic dysfunction during exercise.

et al. 1990

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Left ventricular ejection fraction is normal at rest but may respond abnormally to exercise in many patients with essential hypertension. To assess the determinants of the abnormal ejection fraction response to exercise, we performed radionuclide angiography at rest and during exercise in 41 hypertensive patients without coronary artery disease. In 22 patients (group 1), the ejection fraction increased more than 5% during exercise; in the other 19 patients (group 2), the ejection fraction either increased by less than 5% or decreased with exercise. Left ventricular diastolic filling was impaired at rest in patients in group 2 compared with group 1, with reduced peak filling rate (2.5±0.4 vs. 3.1±0.7 end-diastolic volume/sec; p<0.01) and prolonged time to peak filling rate (175±28 vs. 153+±22 msec; p<0.01). Impaired diastolic filling in group 2 was associated with less augmentation in end-diastolic volume during exercise compared with group 1 (p <0.01). These observations were not dependent on the threshold value that was arbitrarily chosen to define an abnormal ejection fraction response, as there were significant correlations for the entire group between the magnitude of change in ejection fraction with exercise and both the resting peak filling rate (r=0.46) and the change in end-diastolic volume with exercise (r=0.62). Echocardiographic left ventricular mass index was greater in group 2 than in group 1 (141±32 vs. 114+±25 g/m2;p<0.01), and for the entire group was significantly related to peak filling rate (r= -0.50) and time to peak filling rate (r= 0.53). Thus, the abnormal ejection fraction response to exercise in patients with hypertension is related to greater left ventricular mass index and impaired diastolic filling, leading to inadequate augmentation of end-diastolic volume during exercise to maintain systolic function. These findings support the concept that exercise-induced systolic dysfunction in hypertensive patients with left ventricular hypertrophy arises predominantly from diastolic mechanisms. (Circulation 1990;81:978-986

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Abnormal Left Ventricular Relaxation in Hypertensive Patients

Cited by 128 publications

References 15 publications

Ultrasonic Myocardial Texture Versus Doppler Analysis in Hypertensive Heart

Ultrasonic Myocardial Texture Versus Doppler Analysis in Hypertensive Heart

Diastolic Dysfunction in Hypertensive Heart Disease Is Associated With Altered Myocardial Metabolism

Left ventricular hypertrophy and impaired diastolic filling in essential hypertension. Diastolic mechanisms for systolic dysfunction during exercise.

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