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Doppler tissue echocardiography: myocardial wall motion velocities in essential hypertension
G Pelà1, G Bruschi, A Cavatorta
1Dipartimento di Clinica Medica, Nefrologia e Scienze della Prevenzione, University of Parma, Parma, Italy.
Insights
Doppler tissue echocardiography (DTE) reveals impaired relaxation and systolic dysfunction in essential hypertension patients. This technique effectively detects and quantifies hypertensive heart damage, outperforming mitral flow patterns.
Area of Science:
- Cardiology
- Medical Imaging
- Hypertension Research
Background:
- Essential hypertension often leads to left ventricular hypertrophy and diastolic dysfunction.
- Early detection of target-organ damage is crucial for managing hypertension.
- Doppler tissue echocardiography (DTE) offers advanced methods for assessing myocardial function.
Purpose of the Study:
- To evaluate left ventricular function in essential hypertension using Doppler tissue echocardiography (DTE).
- To assess myocardial wall velocities along different planes in hypertensive patients.
- To identify sensitive indices for recognizing hypertensive cardiac damage.
Main Methods:
- Compared 54 hypertensive (HT) patients with 31 normotensive (NT) controls.
- Assessed myocardial velocities (systolic S, diastolic E and A waves) using DTE in short- and long-axis views.
- Measured peak velocities and time-velocity integrals for systolic and diastolic waves.
Main Results:
- Hypertensive patients showed significantly decreased diastolic E-wave relaxation velocity and reduced E/A ratio.
- Systolic S-wave shortening velocity was also reduced in hypertensive individuals.
- DTE variables were more sensitive than mitral flow patterns in discriminating hypertensive patients.
Conclusions:
- DTE confirms impaired relaxation and systolic disturbances in hypertensive patients with left ventricular hypertrophy.
- DTE can detect and quantify target-organ damage in hypertension.
- This technique aids in monitoring treatment response and disease progression.
Aims:
Doppler tissue echocardiography (DTE) was applied to extract the myocardial wall velocities along different planes and evaluate the left ventricular function in essential hypertension.
Methods And Results:
Fifty-four hypertensives (HT) were compared to a control group of 31 normotensive (NT) subjects. The short-axis shortening and lengthening was assessed through the parasternal projections, sampling from interventricular septum and posterior wall. Through the apical projections the mitral annulus excursion was observed at four sites (anterior, posteroseptal, lateral, inferior walls) to assess the longitudinal dynamic of the heart. In each myocardial segment, peak velocity and time-velocity integral for systolic (S) and diastolic waves (E and A) were measured and their means for the long- and short-axis directions were calculated. Significant changes in hypertensives involved mainly the longitudinal motion. In diastole, the E-wave relaxation velocity was significantly decreased and the late A-wave velocity was unchanged. The E/A velocity ratio was significantly reduced. Relaxation velocity was negatively correlated to age, left ventricular mass and diastolic blood pressure. In systole, the peak S-wave shortening velocity was reduced and no association with age, left ventricular mass and blood pressure could be demonstrated. The range of segmental data produced by DTE proved useful to manufacture sensitive indices for recognition of hypertensive damage. Single DTE variables also proved slightly more sensitive than those extracted from the mitral flow pattern for the discrimination of HT patients.
Conclusion:
The presence of impaired relaxation was confirmed by DTE in a large portion of patients with hypertension and left ventricular hypertrophy. A peculiar systolic disturbance is evidenced by this technique. DTE-derived information can be used to detect early and quantify target-organ damage and its progression or regression during antihypertensive treatment.
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