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[Assessment of left ventricular diastolic function in hypertensive patients under different hemodynamic conditions:
Luiz Cláudio Danzmann1, Valéria Centeno de Freitas, Luiz Felipe Araújo
1Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil.
Insights
In hypertensive patients, left ventricular diastolic function assessed by tissue Doppler (E/E' ratio) showed less change than mitral flow velocities (E) during preload increase. This suggests E' is a more stable measure for evaluating diastolic function.
Area of Science:
- Cardiology
- Echocardiography
- Diastolic Function
Background:
- Systemic arterial hypertension can lead to left ventricular (LV) adaptations.
- Assessing LV diastolic function is crucial in hypertensive patients.
- Tissue Doppler imaging (TDI) provides insights into myocardial velocities.
Purpose of the Study:
- To evaluate LV diastolic displacement velocities (E') near the mitral ring using TDI.
- To compare E' with mitral flow velocities (E) during preload changes in hypertensive subjects.
- To assess the impact of preload increase maneuvers on diastolic function indices.
Main Methods:
- Twenty-five hypertensive outpatients underwent echocardiography.
- Measurements included transmitral flow (E, A, E/A) and TDI (E', A', E'/A') variables.
- Preload was increased via passive leg elevation and handgrip exercise.
Main Results:
- Mitral flow velocity (E) significantly increased with preload (p<0.05).
- Tissue Doppler velocity (E') showed minimal change with preload.
- The percentage change in E was significantly greater than E' during preload increase (p=0.01).
Conclusions:
- Hypertensive patients with LV adaptation exhibit preserved E' response to preload.
- E' is less affected by preload variations compared to E in this population.
- E' may be a more reliable index for echocardiographic evaluation of diastolic function in hypertension.
Objective:
To evaluate the behavior of LV diastolic displacement velocities of basal posterior septum near mitral ring segment obtained by tissue Doppler in relation to mitral flow velocities of hypertensive subjects, submitted to preload increase by left inferior limbs elevation for 5 minutes, and during 1 minute of handgrip (conditions 1 and 2, respectively).
Methods:
Twenty five outpatients (15 men, 52+/-11 years), with arterial hypertension > 3 years, by the transmitral flow Doppler variables: E, A and E/A, and of tissue Doppler: E', A' and E'/A', in basal situation and in conditions 1 and 2. For comparison of results in basal situation with conditions 1 and 2 a paired t test was applied.
Results:
E(cm/s) varied from 68,88 +/- 11,94 to 75,82 +/- 15,71* and E'(cm/s) varied from 8,22 +/- 2,30 to 8,31 +/- 2,24 in condition 1 (p<0.05). In addition, a comparison of variation percent (%) of Doppler transmitral indices with corresponding tissue Doppler indices variation % showed a significant difference between E and E', with preload increase (p=0.01).
Conclusion:
Patients with left ventricular adaptation to systemic arterial hypertension showed less modification of the index E' than E, after preload increase maneuver, an evidence that may suggest its more ample utilization in the context of echocardiographic left ventricular diastolic function evaluation.
