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Changes in left ventricular outflow and intraventricular flow patterns in hypertension and controls: a Doppler
Tufan Tükek1, Dogan Erdogan, Saliha Serap Tükek
1Istanbul University, Istanbul School of Medicine, Department of Internal Medicine, Turkey. Tufantukek@hotmail.com
Insights
Hypertensive patients exhibit altered intraventricular flow patterns, with a steeper acceleration slope and shorter pre-ejection period (PEP) below the aortic valve. These changes may indicate a modified contraction pattern and contribute to systolic murmurs.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Intraventricular flow patterns in hypertensive patients with left ventricular hypertrophy can mimic hypertrophic cardiomyopathy.
- Understanding these flow dynamics is crucial for diagnosing and managing hypertensive heart disease.
Purpose of the Study:
- To assess left ventricular outflow and mid-septal intraventricular flow patterns in hypertensive and normotensive individuals.
- To compare flow characteristics between hypertensive patients and healthy controls.
Main Methods:
- Doppler echocardiography was used to evaluate left ventricular outflow and mid-septal flows in 68 hypertensive patients and 45 healthy controls.
- Measurements included acceleration slope, pre-ejection period (PEP), and velocity-time integrals at various points below the aortic valve.
- M-mode echocardiography assessed left ventricular dimensions and function.
Main Results:
- Normotensive individuals showed a consistent decrease in acceleration slope below the aortic annulus with unchanged PEP.
- Hypertensive patients displayed a significant increase in acceleration slope and a decrease in PEP 1 cm below the aortic valve.
- These altered patterns in hypertensive patients reverted to normal further below the aortic valve.
Conclusions:
- The observed increase in acceleration slope and decrease in PEP in hypertensive patients suggest a modified left ventricular contraction pattern.
- This altered pattern may lead to upper septal protrusion into the left ventricular outflow tract.
- These hemodynamic changes could play a role in the development of systolic murmurs in hypertensive individuals.
Objective:
It has been previously reported that intraventricular flow patterns in some hypertensive patients with left ventricular hypertrophy, change to patterns similar to flow profiles of hypertrophic cardiomyopathy. The purpose of the study was to assess left ventricular outflow and mid-septal intraventricular flow patterns in hypertensive and normotensive patients.
Methods:
Left ventricular outflow and mid-septal flows of 68 patients (41 men, mean age 53 +/- 14 years) and 45 non-hypertensive healthy controls (26 men, mean age 43 +/- 16 years) were assessed with Doppler echocardiography. Acceleration slope, pre-ejection period (PEP), and velocity-time integrals of the flows were recorded at the level and 1, 2 and 4 cm below the aortic valve. M-mode parameters of left ventricular wall thicknesses, dimensions and ejection fractions were also recorded. The data was analysed with the paired Student's t test with pre-hoc Bonferoni correction of the level of significance (0.05/4 = 0.0125) for multiple comparisons.
Results:
In normotensive patients the acceleration slope uniformly and statistically significantly decreased beneath the aortic annulus and PEP was unchanged. In hypertensive patients the acceleration slope steepened (1596 +/- 531 vs. 1948 +/- 700 cm/sec, p < 0.05) and PEP decreased (108 +/- 23 vs. 98 +/- 20 msec, p < 0.05) 1 cm below the aortic valve and later reverted to the normal pattern of decrease seen in normotensive patients.
Conclusion:
The increase in acceleration slope and decrease in PEP in the subvalvular region may represent the changing contraction pattern in the hypertensive patients, causing protrusion of the upper septum into left ventricular outflow track and may have a role in the genesis of systolic murmurs.
