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Radionuclide measurements of diastolic function for assessing early left ventricular abnormalities in the
M Caruana1, I Al-Khawaja, A Lahiri
1Department of Cardiology, Northwick Park Hospital, Middlesex.
Insights
Essential hypertension patients show early diastolic filling abnormalities, even with normal systolic function. These findings suggest an early stage of hypertensive heart failure that may be reversible.
Area of Science:
- Cardiology
- Hypertension Research
- Diastolic Function Assessment
Background:
- Essential hypertension is a major risk factor for cardiovascular disease.
- Diastolic dysfunction can precede systolic dysfunction in hypertensive heart disease.
- Early detection of diastolic abnormalities is crucial for timely intervention.
Purpose of the Study:
- To compare diastolic filling measurements in patients with essential hypertension and normotensive controls.
- To identify early diastolic filling abnormalities in essential hypertension.
- To explore the relationship between electrocardiographic abnormalities and diastolic function in hypertensive patients.
Main Methods:
- Compared three diastolic filling measurements using echocardiography in hypertensive and control groups.
- Subdivided hypertensive patients based on electrocardiogram findings.
- Assessed exercise tolerance and its impact on diastolic measurements.
Main Results:
- Patients with essential hypertension exhibited significantly lower early diastolic filling fractions compared to controls.
- This abnormality was present even in hypertensive patients with normal electrocardiograms and systolic function.
- Hypertensive patients with abnormal electrocardiograms showed further reductions in early diastolic filling and prolonged time to peak filling rate.
Conclusions:
- Essential hypertension is associated with early diastolic filling abnormalities, independent of coronary artery disease.
- These diastolic dysfunctions may represent an early stage of hypertensive heart failure.
- Intervention during this potentially reversible stage could prevent disease progression.
Abstract:
Three measurements of diastolic filling were compared in 29 patients with essential hypertension and 27 age matched normotensive controls. Systolic function was normal in all but one of the patients. The mean (1SD) first one third filling fraction (a measurement of early diastolic filling) was significantly lower in the hypertensive groups (0.27 (0.24] than in the control group (0.45 (0.16)). The hypertensive group was subdivided into those with electrocardiographic abnormalities and those without. In the subgroup with a normal electrocardiogram the mean (1SD) first one third filling fraction measurement (0.28 (0.16)) was significantly lower than in the control group. In the subgroup with an abnormal electrocardiogram, the first one third filling fraction was even lower (0.24 (0.9)). In addition, the time to peak filling rate (213 (56) ms) was significantly longer in the subgroup with the abnormal electrocardiogram than in the control group (164 (45) ms). However, the interobserver reproducibility of the time to peak filling measurement was poor. The peak filling rate was low in the subgroup with an abnormal electrocardiogram, but not significantly different from the normal controls. The discriminatory value of the three diastolic measurements did not improve with exercise. These results showed an early diastolic filling abnormality in essential hypertension that did not appear to be caused by disease of the large coronary vessels as it was present in patients with normal wall motion and a normal exercise electrocardiogram. The occurrence of diastolic abnormalities when systolic function is still normal may mark an early stage in the development of hypertensive heart failure, at a time when the process is still potentially reversible.