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[Doppler echocardiographic evaluation of right and left ventricular filling in hypertension]
Insights
Hypertension increases left and right ventricular wall thickness and alters filling patterns. These diastolic changes, particularly the early-to-late filling ratio, correlate with wall thickness, not just LV mass, in hypertensive patients.
Area of Science:
- Cardiology
- Echocardiography
- Hypertension Research
Background:
- Hypertension is associated with cardiac structural and functional changes.
- Ventricular filling dynamics are crucial for assessing diastolic function.
- Echocardiography is a primary tool for evaluating cardiac structure and function.
Purpose of the Study:
- To evaluate left (LV) and right ventricular (RV) filling patterns in untreated hypertensive patients compared to normotensive subjects.
- To investigate the relationship between ventricular filling, LV mass index, and ventricular wall thickness in hypertension.
Main Methods:
- Pulsed Doppler echocardiography was used to assess LV and RV filling in 56 hypertensive (HTN) and 30 normotensive (N) subjects.
- Hypertensive patients were stratified into normal (HTN1) and increased (HTN2) LV mass index groups.
- Measurements included LV wall thickness (h), radius (r), h/r ratio, LV mass index (LV mi), and early-to-late filling ratio (E/A).
Main Results:
- Hypertensive patients (HTN1 and HTN2) showed significantly increased LV wall thickness (h) and h/r ratio compared to normotensive subjects.
- The early-to-late filling ratio (E/A) was significantly decreased in both hypertensive groups compared to normotensive subjects.
- E/A ratios correlated with ventricular wall thickness (h) and h/r ratio in both normotensive and hypertensive individuals, and E/ALV correlated with E/ARV only in hypertensive patients.
Conclusions:
- Hypertension leads to increased ventricular wall thickness and altered diastolic filling, irrespective of LV mass index.
- Ventricular filling patterns (E/A) are more closely related to ventricular wall thickness than LV mass index.
- RV filling alterations in hypertension may be partly explained by diastolic interplay between the ventricles.
Abstract:
Left (LV) and right ventricular (RV) filling was evaluated by pulsed doppler echocardiography in 56 hypertensive (HTN) untreated patients and in 30 normotensive (N) subjects, matched for age, body surface and heart rate. HTN were classified in two groups: HTN1: with normal LV mass index (LV mi) (< 135 g.m-2 for men, < or = 115 g.m.-2 for women); HTN2: with increased LV mi (> or = 135 g.m-2 for men, > or = 115 g.m-2 for women). All subjects had normal systolic function by echo. We derived: LV wall thickness (h), antero-posterior radius (r), h/r ratio, LV mi, ratio of early to late filling (E/A) in both ventricle. RESULTS. h and h/r were significantly in HTN1 (p < 0.01 vs N) and particularly in HTN2 (p < 0.001 vs N and HTA1). E/ALV and E/ARV were significantly decreased (p < 0.001) in both HTA compared to N. There was no significant difference between HTN1 and HTN2 concerning E/ALV and E/ARV. Relations of E/ALV and E/ARV with age, systolic blood pressure (SBP), LV mi, h, h/r: [table: see text] E/ALV is correlated to E/ARV (r = 0.37; p < 0.01) only in HTA. CONCLUSIONS. 1) In HTN in comparison with N: h, h/r are higher in the presence but also in the absence of increased LV mi. 2) In N and HTN: E/ALV and E/ARV are better correlated to h (and also to h/r in N) than to LV mi. Though the respective values of E/ALV and E/ARV are identical, they are correlated significantly only in HTN. 3) In the absence of the direct measures of the RV pressures and volumes, the interpretation of the results concerning the RV filling in uncertain. Only in HTN, they could be explained at least in part by the diastolic interplay between the two ventricles.