[A trans-mitral Doppler echocardiographic study in arterial hypertension]

The echocardiographic study of trans-mitral blood flow allows an early and reliable detection of left ventricular diastolic abnormalities in patients with arterial hypertension. Such abnormalities may develop very early in the course of hypertensive cardiopathy, even before left ventricular hypertrophy is detectable. Early diastolic peak flow velocity (peak E), reflecting passive left ventricular filling, late diastolic peak flow velocity (peak A), reflecting ventricular filling following atrial contraction, and peak A/peak E ratio are the most important indirect indicators of left ventricular diastolic performance. In our experience, an unselected hypertensive population with a low prevalence of left ventricular hypertrophy (about 12 per cent) showed a very high prevalence (more than 40 per cent) of early diastolic filling abnormalities. Age, heart rate during Doppler examination and blood pressure were the most important predictors of early diastolic abnormalities in a multivariate statistical model. Ambulatory blood pressure yielded a more stronger predictivity in comparison with clinic (casual) blood pressure. Further studies are needed to clarify the natural history of these early diastolic abnormalities and the effect of antihypertensive therapy in terms of possible regression of these early changes.