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Left ventricular diastolic function in hypertension: relation to left ventricular mass and systolic function
Insights
Hypertension impairs left ventricular filling rates, especially with increased left ventricular mass. Diastolic dysfunction in hypertensive patients correlates with cardiac structure, not systolic performance.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- Diastolic cardiac function abnormalities in hypertension precede systolic changes.
- Left ventricular filling rate is an early indicator of diastolic dysfunction.
Purpose of the Study:
- To investigate the relationship between hypertension, left ventricular mass, and impaired left ventricular filling.
- To determine the correlation between diastolic dysfunction and systolic performance in hypertensive patients.
Main Methods:
- M-mode echocardiography, radionuclide first pass technique, and gated blood pool scintigraphy were used.
- Three groups were studied: normal subjects, hypertensive patients without left ventricular hypertrophy, and hypertensive patients with left ventricular hypertrophy.
Main Results:
- Systolic function indexes were similar across all groups.
- Maximal left ventricular filling rate and fast filling fraction decreased progressively with increasing left ventricular mass.
- Diastolic dysfunction was statistically significant in hypertensive patients with left ventricular hypertrophy.
Conclusions:
- Hypertension, particularly with left ventricular hypertrophy, leads to impaired left ventricular diastolic filling.
- Left ventricular maximal filling rate is inversely related to left ventricular mass and end-systolic diameter.
- Diastolic dysfunction in hypertension is not correlated with systolic performance but with structural changes.
Abstract:
Initial studies of diastolic cardiac function in hypertension demonstrated that slowing of the maximal rate of left ventricular filling occurred before alterations in either ejection fraction or cardiac output. The present study was undertaken to determine: 1) the relation between hypertension, increased left ventricular mass and impaired left ventricular filling, and 2) the correlation between abnormalities in left ventricular diastolic function and its systolic performance. Eleven normal subjects (Group 1), 5 hypertensive patients without evidence of left ventricular hypertrophy (Group 2) and 18 hypertensive patients with increased left ventricular mass by echocardiography (Group 3) were studied by M-mode echocardiography, radionuclide (technetium-99m human serum albumin) first pass technique and gated blood pool scintigraphy. Indexes of systolic function (ejection fraction, maximal rate of ejection and percent left ventricular shortening) were essentially similar in hypertensive and normotensive subjects. No correlation was found between systolic blood pressure and left ventricular mass (r = 0.20, not significant). Maximal rate of left ventricular filling (P dV/dt) and fast filling fraction decreased progressively from Group 1 to Group 3 (2.36 +/- 0.4 [mean +/- standard deviation], 2.17 +/- 0.3 and 1.97 +/- 0.4 s-1, respectively, for P dV/dt and 46 +/- 7, 48 +/- 9 and 38 +/- 11%, respectively, for fast filling fraction); the difference from values in normal subjects reached statistical significance in hypertensive patients with left ventricular hypertrophy. Left ventricular maximal filling rate correlated inversely with left ventricular mass and left ventricular end-systolic diameter (r = -0.74), but positively with left ventricular fractional shortening and ejection fraction (r = 0.70).(ABSTRACT TRUNCATED AT 250 WORDS)