Left Ventricular Diastolic Dysfunction Assessed by Conventional Echocardiography and Spectral Tissue Doppler Imaging in Adolescents With Arterial Hypertension

Abstract

Compared to conventional echocardiography, spectral tissue Doppler imaging (s-TDI) allows more precise evaluation of diastolic cardiac function. The purpose of this study was to conduct s-TDI to analyze the slow movement of the left ventricular (LV) myocardium in adolescents with systemic arterial hypertension (HT) and to determine whether patients with HT suffer from LV diastolic dysfunction. The study group comprised 69 consecutive patients (48 boys and 21 girls aged 14–17 years [mean, 15.5 ± 1.1 years]) with primary HT, and the control group comprised 48 healthy participants (24 boys and 24 girls aged 14–17 years [mean, 15.8 ± 1.3 years]). Physical examinations, 24-hour arterial blood pressure monitoring, conventional 2-dimensional and Doppler echocardiography, and s-TDIs were performed. Analysis revealed that study group participants were significantly heavier and had greater LV mass indices than controls (P < 0.001). There were no differences between the velocities of E waves (peak early filling of mitral inflow), but the deceleration times of the mitral E waves were significantly shorter whereas the A waves survived longer in the study group than in the control group. The velocities of A waves (peak late filling of mitral inflow) were elevated (P = 0.041), and the E/A wave pattern (E/A = 1.8 ± 0.4) was normal. These results suggest pseudonormalization, a type of LV diastolic dysfunction in adolescents with HT.In the study group, when the sample volume was positioned at the septal or lateral insertion site of the mitral leaflet, the e′ wave velocity was significantly depressed whereas the a′ wave velocity was elevated, compared to those of the control group (P < 0.001).The e′/a′ ratios from the septal and lateral insertion sites were lower, whereas the E/e′ ratio from the septal insertion site was significantly higher in the study group, similar to that seen in atrial reversal velocity (P < 0.001).These findings indicate that using sTDI to find and measure diastolic LV failure is valuable when the probe is placed at the septal and lateral mitral valve annuli during examination.Changes in the myocardium appear similar to those seen in adults.

Values of hemodynamic variation in response to passive leg raising in predicting exercise capacity of heart failure with preserved ejection fraction

“…E/A ratio usually decreased to be less than 1 in patients with diastolic dysfunction. [ 33 , 34 ] A higher E/A ratio in group 1 likely represents a less degree of diastolic stiffness, and therefore a better cardiac preload reserve, [ 35 ] which in itself would predict a better response to 6MWT. The present study showed that group 1 had significantly higher 6MWD than group 2 (515.38 ± 24.97 vs 306.39 ± 20.20 m; P = 0.043).…”

Systolic and diastolic left ventricular function in children with primary hypertension: a systematic review and meta-analysis

“…There were 2860 individuals aged 5-19 years in 17 studies [16][17][18][19][20][21][22][23]26,27,[29][30][31][32][33][34][35] who underwent evaluation of any measure of LV systolic function (Table 1). These included 41% (1168/2860) with elevated BP (including HT), 67% male [sex reported in 16 studies, [16][17][18][19][20][21][22][23]26,27,[30][31][32][33][34][35]). EF was employed to measure LV function in all the 15 studies; FS was analyzed in 11 studies [17,19,20,22,25,26,[29][30][31][32]34]; in five studies [18,20,22,24,…”

Serum apoptotic marker M30 is positively correlated with early diastolic dysfunction in adolescent obesity

“…These changes in diastolic function were subclinical. Childhood studies found higher E/e’ and lower e’/a’ in children with hypertension [40], and hypertrophic cardiomyopathy [41]. However, there is no cutoff value for E/e’ or lateral e’ velocity to indicate diastolic dysfunction in children and adolescents.…”