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Echocardiographic assessment by computer-assisted analysis of diastolic left ventricular function and hypertrophy in
Insights
Hypertension can lead to heart failure, but early diastolic dysfunction, specifically impaired left ventricular (LV) relaxation, is detectable even in mild hypertension before systolic issues arise.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Systemic hypertension is a primary risk factor for congestive heart failure.
- Left ventricular (LV) systolic function often remains preserved in early to moderate hypertension.
- Diastolic dysfunction may precede systolic impairment in hypertensive heart disease.
Purpose of the Study:
- To investigate early changes in left ventricular (LV) systolic and diastolic function in patients with borderline and mild hypertension.
- To assess the presence and degree of LV hypertrophy in relation to blood pressure levels.
Main Methods:
- M-mode echocardiography was performed on 7 borderline hypertensive, 14 mild hypertensive, and 15 normal subjects.
- Systolic and diastolic LV function parameters were analyzed using digital image processing.
- Left ventricular hypertrophy (LVH) was quantified and correlated with blood pressure.
Main Results:
- Systolic LV function indices were comparable across all groups (normal, borderline, mild hypertension).
- Mild hypertension was associated with significantly decreased peak rate of early LV posterior wall relaxation (4.7 vs 6.6 sec-1, p<0.01).
- Mitral valve closure rate was significantly reduced in borderline (119 mm/s) and mild hypertensive (106 mm/s) groups compared to normal (150 mm/s).
- Mild LVH was prevalent in 86% of borderline and 93% of mild hypertensive patients.
- Correlation between the degree of LVH and blood pressure levels was poor.
Conclusions:
- Early diastolic dysfunction, characterized by impaired LV relaxation and reduced mitral valve closure rate, is present in patients with mild to moderate hypertension.
- Systolic LV function remains largely preserved in these hypertensive groups.
- Diastolic abnormalities may serve as an early indicator of hypertensive heart disease, preceding overt systolic dysfunction or significant hypertrophy.
Abstract:
Systemic hypertension is a common cause of congestive heart failure. However, left ventricular (LV) systolic function remains normal for many years in patients with mild or moderate hypertension. In this study, high-quality M-mode echocardiograms were recorded in 7 patients with borderline hypertension, 14 patients with mild hypertension and 15 normal persons. Measures of systolic and diastolic LV function and the degree of LV hypertrophy were studied with the assistance of a tablet digitizer and dedicated microcomputer. Average blood pressure was 125 +/- 10/77 +/- 7 mm Hg in normal subjects, 146 +/- 18/92 +/- 2 mm Hg in patients with borderline hypertension and 150 +/- 11/102 +/- 4 in patients with mild hypertension. Indexes of systolic LV function were similar in all 3 groups. The peak rate of early relaxation of the LV posterior wall was significantly decreased in the group of patients with mild hypertension (4.7 vs 6.6 sec-1, p less than 0.01). The mitral valve closure rate was 150 +/- 32 mm/s in normal subjects, 119 +/- 35 mm/s in patients with borderline hypertension and 106 +/- 26 mm/s (p less than 0.001) in patients with mild hypertension. Mild LV hypertrophy was present in 6 of 7 patients with borderline and 13 of 14 patients with mild hypertension. The degree of hypertrophy and the level of blood pressure correlated poorly.(ABSTRACT TRUNCATED AT 250 WORDS)