Doppler echocardiographic assessment of left ventricular systolic and diastolic function in mild hypertension.

Abstract

SUMMARY Abnormalities in left ventricular (LV) wall thickness and mass have been demonstrated in patients with mild hypertension utilizing M-mode echocardiography. In addition, studies using radionuclide angiography have demonstrated abnormalities in early diastolic LV filling in asymptomatic hypertensive patients with normal ejection fraction and cardiac output. Recently, Doppler recordings of flow velocity in the ascending aorta and through the mitral valve have been shown to provide useful information about LV function. To determine whether flow abnormalities could be detected in patients with mild hypertension, we recorded Doppler aortic and mitral valve flow velocities in 21 men with mild hypertension. Casual systolic blood pressure was 147 ± 18 mm Hg (mean ± SD) and diastolic blood pressure was 96 ± 9 mm Hg. LV mass (310 ± 75 g) was elevated (i.e., above the 95% normal prediction interval) in 8 of 19 patients who underwent M-mode echocardiography; LV ejection fraction was normal in all patients (mean, 80%). As in previous studies in normal subjects, we found in these hypertensive patients an inverse correlation between age and both aortic peak flow velocity (r = -0.51, p < 0.05) and transmitral early diastolic peak flow velocity (r = -0.44, p<0.05) and a positive relationship between age and mitral valve late diastolic peak flow velocity (r = 0.73, p<0.001). Compared to age-corrected normal data, the following mitral flow velocity parameters were abnormal: early diastolic deceleration time (mean, 28% above predicted normal; p<0.005), rate of deceleration of early diastolic flow velocity (mean, 14% below predicted normal; p<0.005), and late diastolic flow time (mean, 17% above normal; p<0.005). Neither aortic peak flow velocity nor mitral early or late diastolic peak flow velocity correlated with echocardiographic LV mass or with casual or 24-hour average systolic or diastolic blood pressure. Only transmitral late diastolic flow velocity integral (area under flow velocity curve) was significantly correlated with LV mass (r = 0.54, p<0.02). We conclude that patients with mild hypertension have normal aortic and transmitral peak flow velocities despite the presence of increased echocardiographic LV muscle mass. However, Doppler evidence of LV filling abnormalities -including a diminished rate of deceleration of early diastolic transmitral flow velocity and increased early diastolic deceleration time and late diastolic flow time -can be detected in these patients.

The prevalence of diastolic dysfunction in adult hypertensive Nigerians

“…Combined alterations of these influencing factors may actually "pseudonormalize" the transmitral flow pattern, thus complicating the evaluation of diastolic filling, especially with the presence of both prolonged relaxation and restrictive filling abnormalities However, Philips et al 25 rather discovered abnormal left ventricular filling rates only in patients with systolic blood pressure (SBP) higher than 130mmHg, but not in those patients with SBP lower than 130mmHg. Contrariwise, Gardin et al 26 in a study in a group of 21 mild hypertensive patients, found normal values of peak E velocity, peak A velocity and normal A:E ratio, with no diastolic dysfunction in the hypertensive group. This result has, however, been attributed to the fact that Gardin and his associates had relatively low blood pressures in the hypertensive group they studied (clinic blood pressure: 147.9/95.8mmHg; average 24 hours blood pressure: 137.1/83.2 mmHg).…”

Ultrasonic Myocardial Texture Versus Doppler Analysis in Hypertensive Heart

“…24,39 The analysis of transmitral flow velocity has provided a means of simple evaluation of global diastolic function. 40 The diastolic abnormalities precede systolic impairment and the evolution toward congestive cardiopathy. In the pressurevolume hypertensive overload in particular, an alteration of the passive end-diastolic phase (increased stiffness) was observed.…”

The heart in the hypertensive elderly

“…[25][26][27] Impaired diastolic filling has been found to be a very early sign of hypertensive heart disease which occurs even before an increase in LV mass can be identified. In our study, older subjects with normal LV mass presented with impairment of LV relaxation similar to that of younger patients with LVH.…”