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Left ventricular diastolic function in physiologic and pathologic hypertrophy
Christiana M Schannwell1, Markus Schneppenheim, Gunnar Plehn
1Clinic of Cardiology, Pneumology and Angiology, University Hospital Duesseldorf, Germany. schannw@uni-duesseldorf.de
Insights
Physiologic left ventricular hypertrophy from endurance training does not impair diastolic filling. Pathologic hypertrophy from hypertension causes diastolic dysfunction, distinguishing these conditions using Doppler echocardiography.
Area of Science:
- Cardiology
- Exercise Physiology
- Echocardiography
Background:
- Hypertensive heart disease and left ventricular hypertrophy (LVH) are linked to impaired diastolic filling.
- Physiologic LVH from endurance training's effect on diastolic filling is not well understood.
Purpose of the Study:
- To investigate if physiologic LVH from endurance training causes systolic and diastolic filling disturbances.
- To differentiate between physiologic and pathologic LVH using echocardiographic parameters.
Main Methods:
- Conventional echocardiography and Doppler assessment of LV diastolic filling in athletes with LVH, hypertensive patients with LVH, and controls.
- Evaluated left ventricular (LV) muscle mass index, fractional shortening, and diastolic filling velocities.
Main Results:
- Athletes and hypertensive patients had higher LV muscle mass indices than controls.
- Hypertensive patients showed diastolic dysfunction with delayed relaxation and altered filling velocities.
- Athletes with physiologic LVH exhibited normal LV diastolic filling patterns.
Conclusions:
- Doppler echocardiographic parameters differentiate between pathologic (hypertension-induced) and physiologic (endurance training-induced) LVH.
- Physiologic LVH does not compromise diastolic function.
Background:
Patients with hypertensive heart disease and left ventricular hypertrophy demonstrate an impaired left ventricular diastolic filling pattern. The aim of this study was to find out whether physiologic left ventricular hypertrophy induced by endurance training causes disturbances in left ventricular systolic and diastolic filling.
Methods:
We examined 49 athletes with left ventricular (LV) hypertrophy due to endurance training, 49 patients with LV hypertrophy due to arterial hypertension, and 26 untrained healthy control subjects by conventional echocardiography. Parameters of LV diastolic filling using pulse wave and color flow Doppler were also assessed.
Results:
All three study groups showed normal fractional shortening and mid-wall fractional shortening. Conventional echocardiography revealed a higher LV muscle mass index in the two study groups compared with the controls (athletes, 99 +/- 10 g; hypertensive patients, 95 +/- 11 g: controls: 52 +/- 7 g; P < .01 for athletes and hypertensive patients). In patients with arterial hypertension, a diastolic dysfunction consisting of a delayed relaxation pattern with a decrease in maximal early velocity of diastolic filling (0.44 +/- 0.1 m/sec) and a compensatory increase of the maximal late velocity of diastolic filling (0.53 +/- 0.1 m/sec) was demonstrated. In athletes with physiologic LV hypertrophy, a normal LV diastolic filling pattern was documented.
Conclusions:
Doppler echocardiographic parameters of LV diastolic function can be of diagnostic importance for discrimination between pathologic and physiologic LV hypertrophy.