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Echocardiographic assessment of left ventricular diastolic performance in hypertensive subjects. Correlation with
Insights
Early detection of cardiac changes in hypertensive patients is crucial. Prolonged left ventricular isovolumic relaxation time (IVRT) and increased left atrial size may indicate subtle left ventricular hypertrophy in hypertension.
Area of Science:
- Cardiology
- Hypertension Research
- Diagnostic Imaging
Background:
- Left ventricular hypertrophy (LVH) in hypertension leads to significant morbidity and mortality.
- Early detection of cardiac changes is vital for managing hypertensive heart disease.
- Distinguishing pathologic LVH from normal variation in mild to moderate hypertension requires sensitive markers.
Purpose of the Study:
- To evaluate left ventricular diastolic function and left atrial size as early indicators of cardiac changes in hypertension.
- To correlate left ventricular isovolumic relaxation time (IVRT) and left atrial dimensions with left ventricular mass index and ventricular filling.
Main Methods:
- M-mode echocardiography to measure left ventricular mass index.
- Radionuclide ventriculography to assess rapid left ventricular filling.
- Measurement of left ventricular isovolumic relaxation time (IVRT) and left atrial dimensions in 20 untreated hypertensive patients and controls.
Main Results:
- Hypertensive subjects showed significantly prolonged IVRT (91 ± 23 ms vs. 65 ± 13 ms) and increased left atrial dimension index (1.9 ± 0.4 cm/m² vs. 1.4 ± 0.5 cm/m²).
- Prolonged IVRT was correlated with increased left atrial size (r=0.46) and increased left ventricular mass.
- Abnormal IVRT correlated with decreased rapid ventricular filling in hypertensive individuals.
Conclusions:
- Prolonged IVRT and borderline left atrial dimensions may identify subtle pathologic left ventricular mass increases in hypertensive patients.
- These parameters can aid in the early diagnosis of cardiac remodeling in early-stage hypertension.
- Diastolic function parameters and atrial size are valuable for detecting subclinical cardiac changes in hypertension.
Abstract:
Left ventricular hypertrophy resulting from hypertension is accompanied by significant morbidity and mortality and in advanced stages may be irreversible. Hence, early detection of cardiac changes in hypertensive patients remains an important diagnostic goal. When the hypertrophy is mild or moderate, parameters of left ventricular diastolic function and measurements of left atrial size may facilitate the distinction between normal variation and pathologic increases in left ventricular mass. We measured left ventricular isovolumic relaxation time (IVRT, the time from aortic valve closure to mitral valve opening) and left atrial dimensions and correlated them to left ventricular mass index measured by M-mode echocardiography and rapid left ventricular filling by radionuclide ventriculography. In 20 subjects with untreated mild essential hypertension, IVRT was prolonged compared to a normotensive age-matched control group (91 +/- 23 vs 65 +/- 13 msec, p less than 0.0001). Left atrial dimension index was increased in patients compared to controls (1.9 +/- 0.4 vs 1.4 +/- 0.5 cm/m2, p less than 0.001), and this increase was related to prolonged IVRT (r = 0.46, p less than 0.001). Abnormal IVRT correlated with both increased left ventricular mass and decreased rapid ventricular filling in the hypertensive subjects. Thus, prolonged IVRT and borderline left atrial dimension may help identify subtle pathologic left ventricular mass increases in hypertensive subjects.