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Ultrasonic backscatter and diastolic function in hypertensive patients
Alicia M Maceira1, Joaquín Barba, Oscar Beloqui
1Department of Cardiology, University Clinic, University of Navarra, Pamplona, Spain.
Insights
Ultrasonic reflectivity, measured by integrated backscatter analysis, shows diminished cyclic variation in hypertensive patients with diastolic dysfunction. This finding aids in assessing diastolic dysfunction severity in hypertension.
Area of Science:
- Cardiology
- Medical Imaging
- Hypertension Research
Background:
- Essential hypertension is linked to cardiac structural and functional changes.
- Diastolic dysfunction is a common complication of hypertension, affecting cardiac filling and performance.
- Assessing diastolic dysfunction severity is crucial for managing hypertensive heart disease.
Purpose of the Study:
- To investigate the relationship between ultrasonic reflectivity, specifically integrated backscatter analysis, and the severity of diastolic dysfunction in patients with essential hypertension.
- To determine if backscatter cyclic variation and maximal intensity can serve as markers for diastolic dysfunction in hypertension.
Main Methods:
- One hundred nine patients with essential hypertension were included.
- Diastolic function was assessed using Doppler echocardiography and mitral-inflow Doppler ultrasound.
- Real-time integrated backscatter analysis measured backscatter cyclic variation and maximal intensity in the left ventricle.
- Patients were categorized into five groups based on blood pressure and diastolic function severity.
Main Results:
- Diminished cyclic variation of backscatter was observed in hypertensive patients with more severe diastolic dysfunction (restrictive and pseudonormal filling patterns).
- Cyclic variation was inversely correlated with left ventricular chamber stiffness and directly correlated with midwall fractional shortening.
- No significant differences in maximal intensity were found across the patient groups.
Conclusions:
- Reduced cyclic variation of ultrasonic backscatter is associated with impaired diastolic function in hypertensive patients.
- Alterations in backscatter cyclic variation may be a valuable tool for assessing diastolic dysfunction in the context of hypertension.
- Integrated backscatter analysis offers a potential non-invasive method for evaluating cardiac changes in hypertensive individuals.
Abstract:
This study was designed to assess whether ultrasonic reflectivity, evaluated by a real-time integrated backscatter analysis, was related to the severity of diastolic dysfunction, as studied by Doppler echocardiography in patients with essential hypertension. One hundred nine subjects were included in the study. Diastolic function was assessed by mitral-inflow Doppler ultrasound recordings. Backscatter cyclic variation and maximal intensity were measured in 6 regions throughout the left ventricle. The subjects were classified in 5 groups according to blood pressure and diastolic function: 29 normotensives with normal diastolic function (group 1), 18 hypertensives with normal diastolic function (group 2), 47 hypertensives with a delayed relaxation pattern (group 3), 11 hypertensives with a pseudonormal filling pattern (group 4), and 4 hypertensives with a restrictive filling pattern (group 5). The highest cyclic variation was found in groups 1 and 2, the lowest in groups 4 and 5 (5.7+/-0.2 dB in group 1 and 5.7+/-0.2 dB in group 2 versus 2.9+/-0.3 dB in group 4 and 2.1+/-0.4 dB in group 5; P<0.001), with intermediate values in group 3 (5.2+/-0.2 dB). Cyclic variation was inversely correlated with left ventricular chamber stiffness (P<0.05) and directly correlated with midwall fractional shortening (P<0.02) in all hypertensives. No differences in maximal intensity were found among the 5 groups of subjects. These results show an association between diminished cyclic variation of backscatter and deterioration of diastolic function in hypertensive patients. Thus, alterations in this parameter may be useful for the assessment of diastolic dysfunction in hypertension.