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The evolution of diastolic dysfunction in the hypertensive disease
Harry Pavlopoulos1, Julia Grapsa, Ellie Stefanadi
1Cardiology Department, National Heart and Lung Institute (NHLI), Imperial College of Medicine and Technology, Hammersmith Hospital, Du Cane Rd, W12 0HS London, UK. drpavlo@yahoo.com
Summary
Diastolic dysfunction (DD) in hypertension appears early, even before significant cardiac remodelling or hypertrophy. As left ventricular (LV) remodelling progresses, diastolic function deteriorates, with tissue Doppler indices proving more reliable than blood-pool indices.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Medical Imaging
Background:
- Cardiac remodelling, a consequence of hypertension, alters heart size, shape, and function.
- Left ventricular (LV) diastolic function is crucial for maintaining cardiac output and is often impaired in hypertensive individuals.
- Tissue Doppler and blood-pool indices offer different perspectives on evaluating LV diastolic function.
Purpose of the Study:
- To assess the impact of cardiac remodelling on LV diastolic function in hypertensive patients.
- To compare the efficacy of tissue Doppler imaging versus blood-pool indices in evaluating diastolic dysfunction (DD) in relation to LV remodelling and wall stress.
- To identify predictors of DD in hypertensive disease.
Main Methods:
- Evaluated 90 hypertensive patients and 30 healthy controls, categorizing hypertensives into normal remodelling, concentric remodelling, and concentric hypertrophy groups.
- Measured mitral annular early diastolic (Ea) velocities, filling pressures (E/Ea), relative wall thickness, LV mass index, deceleration time (DT), isovolumic relaxation time (IVRT), E/A ratio, and longitudinal wall stress (LWS).
- Diagnosed DD using established criteria and analyzed correlations between echocardiographic parameters and clinical factors.
Main Results:
- An increased incidence and progression of DD were observed with advancing LV remodelling and LV mass. DD was present even in patients with normal remodelling (36.6% incidence).
- Tissue Doppler indices, particularly septal Ea, showed stronger correlations with LV remodelling parameters (LVMI, RWT) and clinical factors (SBP, age) than blood-pool indices.
- LV mass index, systolic blood pressure, and age were identified as independent predictors of DD in a multivariate analysis.
Conclusions:
- Diastolic dysfunction manifests early in hypertensive disease, preceding overt cardiac remodelling or hypertrophy.
- Progressive deterioration of diastolic function accompanies the advancement of LV remodelling and hypertrophy.
- Tissue Doppler indices provide a more robust assessment of LV remodelling-related DD compared to blood-pool indices.
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