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Age and blood-pressure-related changes in left ventricular diastolic filling
S Bongiovì1, P Palatini, F Macor
1Clinica Medica I, University of Padua, Italy.
Insights
Hypertension impairs left ventricular diastolic filling, particularly in older adults. Age is the primary factor, but 24-hour blood pressure also significantly affects diastolic function.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Diagnostic Imaging
Background:
- Left ventricular diastolic filling is crucial for cardiac function.
- Hypertension is a known risk factor for cardiovascular disease.
- Understanding diastolic dysfunction in hypertension is vital for patient management.
Purpose of the Study:
- To investigate the impact of clinical and echocardiographic factors on left ventricular diastolic filling.
- To compare diastolic filling parameters between hypertensive and normotensive individuals.
Main Methods:
- Echocardiography with pulsed Doppler was used to assess left ventricular filling.
- Non-invasive 24-hour blood pressure monitoring was conducted in hypertensive subjects.
- Analysis included correlations between blood pressure, age, and diastolic filling indices.
Main Results:
- Hypertensive individuals exhibited significantly lower early to atrial peak diastolic filling velocity and area ratios.
- Age, 24-hour blood pressure, left atrial dimension, and left ventricular mass index correlated with diastolic filling.
- 24-hour blood pressure was the strongest correlate of diastolic filling, independent of age and heart rate.
Conclusions:
- Age is the most significant clinical correlate of left ventricular diastolic function.
- Elevated 24-hour blood pressure is associated with impaired diastolic performance in hypertensive patients.
- Diastolic dysfunction is more pronounced in older hypertensive individuals compared to normotensives.
Purpose:
To evaluate the influence of different clinical and echocardiographic parameters on left ventricular diastolic filling in 66 mild to moderate hypertensives and 49 normotensives.
Methods:
All subjects underwent an echocardiographic study with a pulsed Doppler evaluation of left ventricular filling. The hypertensive subjects also underwent non-invasive 24-h blood pressure monitoring.
Results:
The ratio of early to atrial peak diastolic filling velocity and the ratio of the corresponding areas under the curve (AUC) were significantly lower in the hypertensives compared with the normotensives (P less than 0.001). In the hypertensives, office blood pressure, average 24-h mean blood pressure, the left atrial dimension and the left ventricular mass index were each related both to age and to diastolic filling. The variable most closely related to diastolic filling independently of age and the R-R interval was 24-h blood pressure (ratio of early: atrial peak filling velocity versus 24-h blood pressure: r = -0.307, P less than 0.05; ratio of early: atrial AUC versus 24-h blood pressure: r = -0.261, P less than 0.05). When the normotensives and hypertensives were each grouped according to age less than or equal to or greater than 40 years, the normotensive-hypertensive mean difference was greater in the subjects aged greater than 40 years for both the early:atrial maximal velocity ratio and the early:atrial AUC ratio.
Conclusions:
Age is the strongest clinical correlate for left ventricular diastolic function indices, in both hypertensives and normotensives. In the present study, average 24-h blood pressure and, to a lesser extent, the heart rate were also associated with an impaired diastolic performance.