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Left ventricular filling patterns in patients with systemic hypertension and left ventricular hypertrophy (the LIFE
K Wachtell1, G Smith, E Gerdts
1Copenhagen County University Hospital, Glostrup, Denmark. wachtell@dadlnet.dk
Insights
Abnormal left ventricular filling is common in hypertension. Prolonged isovolumetric relaxation time (IVRT) is linked to left ventricular hypertrophy (LVH) and mass, even with normal echocardiographic geometry.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Abnormal left ventricular (LV) filling can occur in early hypertension.
- The relationship between diastolic dysfunction and LV hypertrophy (LVH) in hypertensive patients is debated.
Purpose of the Study:
- To investigate the association between abnormal diastolic LV filling and LV geometry.
- To assess these relationships in a large cohort of hypertensive patients with electrocardiographic LVH.
Main Methods:
- 750 hypertensive patients with ECG-defined LVH underwent echocardiography.
- Evaluated mitral inflow velocity and isovolumetric relaxation time (IVRT).
- Classified LV geometry into normal, concentric remodeling, eccentric LVH, and concentric LVH.
Main Results:
- 16% had normal LV filling, 69% abnormal relaxation, 11% pseudonormal, 4% restrictive.
- Prolonged IVRT correlated with LV hypertrophy and elevated relative wall thickness.
- LV mass was independently associated with prolonged IVRT, not other filling parameters.
Conclusions:
- Abnormal IVRT is prevalent across all LV geometric patterns in hypertensive patients with ECG-LVH.
- IVRT differences were mainly driven by LV mass, highlighting its role in diastolic dysfunction.
Abstract:
Abnormal left ventricular (LV) filling may exist in early stages of hypertension. Whether this finding is related to LV hypertrophy is currently controversial. This study was undertaken to assess relations between abnormal diastolic LV filling and LV geometry in a large series of hypertensive patients with electrocardiographic LV hypertrophy. M-mode, 2-dimensional, and pulsed Doppler echocardiographic recordings of mitral inflow velocity and isovolumetric relaxation time (IVRT) were obtained in 750 patients with stage I to III hypertension and LV hypertrophy determined by electrocardiography (sex-adjusted Cornell voltage duration criteria or Sokolow-Lyon voltage criteria) after 14 days of placebo treatment. The patients' mean age was 67+/-7 years and 44% were women. One hundred forty patients (19%) had normal LV geometric pattern, 79 (11%) had concentric remodeling, 342 (45%) had eccentric LV hypertrophy, and 189 (25%) had concentric LV hypertrophy. A normal LV filling pattern was found in 116 patients (16%), abnormal relaxation in 519 (69%), "pseudonormal" filling was found in 83 (11%), and a restrictive filling pattern in 32 (4%). Prolonged IVRT was associated with LV hypertrophy (p<0.01) as well as elevated relative wall thickness (p<0.05). A stronger difference (p<0.01) in IVRT was found between groups with and without LV hypertrophy. Multiple regression analysis revealed that increased LV mass correlated with prolonged IVRT, whereas LV mass and geometry were not associated with peak early LV filling velocity (E), peak atrial filling velocity (A) ratio or mitral valve E-peak deceleration time, although IVRT was found to be an independent correlate of E/A ratio and deceleration time. Thus, abnormal IVRT was highly prevalent in all LV geometric subgroups among hypertensive patients with electrocardiographic LV hypertrophy, even in those with normal LV geometry determined by echocardiography. We found that IVRT differed significantly among patient groups with different LV geometric patterns, primarily because of the association of IVRT to LV mass.