Arterial stiffness and left ventricular diastolic function in the patients with hypertension

Arterial hypertension is associated with accelerated atherosclerosis resulting in increased arterial stiffness. It is well known that left ventricular diastolic function declines in patients with hypertension. The study aims to determine the relationship between arterial stiffness and left ventricular diastolic dysfunction in patients with hypertension with preserved left ventricular ejection fraction using newly developed ultrasonic imaging.

We performed a cross-sectional study including 65 patients with hypertension. Left ventricular systolic and diastolic function was evaluated by 2D-, M-mode by measuring transmitral flow velocity, mitral annular motion velocity using a conventional and tissue Doppler (TDI) ultrasonic system. Asymptomatic atherosclerosis was also determined by measuring the intimae media thickness and stiffness of the common carotid arteries using 2D-, M-mode and tissue Doppler by ultrasonography.

According to conventional Doppler echocardiography of transmitral and tissue Doppler, diastolic function was classified as normal in 38 patients and abnormal in 27 patients. Of those with diastolic dysfunction, 14 had mild (impaired relaxation) and 13 had advanced (pseudonormal filling) dysfunction. Univariate analysis revealed that index was negatively associated with Em (r = -0.328, p = 0.005), as well as with Em/Am ratio (r = -0.446, p = 0.002). Moreover, a multivariate analysis showed that the TDI-derived Em/Am ratio was significantly associated with age (p = 0.001), relative wall thickness (p = 0.006) and index beta (p = 0.03), while the conventional Doppler-derived E/A ratio was significantly associated only with age (p = 0.001). Arterial stiffness index was the highest in patients with hypertension and normal function (10.2 +/- 3.4) and progressively increased in patients with impaired relaxation (11.5 +/- 3.9), and pseudonormal filling (12.8 +/- 4.5). In a stepwise multiple regression analysis model including: age, systolic and diastolic blood pressure, pulse pressure, body mass index, and beta index the only factor independently correlated to arterial stiffness was left ventricular average peak systolic velocity.

Our data confirm the positive correlation between diastolic dysfunction and arterial stiffness, and suggest that non-invasive assessment of the 13 index might be useful for studying the effects on arterial stiffness of treatment designed to optimize cardiac performance in patients with hypertension. Arterial stiffness is an independent predictor of diastolic dysfunction in hypertensive patients and should be considered a potential target for intervention in diastolic heart failure. TDI-detected left ventricular diastolic dysfunction is accompanied by increased arterial stiffness in newly diagnosed essential hypertension.