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Left ventricular diastolic function in hypertensive patients with unstable angina and single coronary artery disease
I F Islim1, R Ahmad, D Bareford
1Cardiology Department, City Hospital, Birmingham, England.
Insights
Hypertensive patients with unstable angina exhibit significant left ventricular diastolic (LVD) dysfunction, independent of left ventricular mass and ischemia. This dysfunction may stem from increased left ventricular stiffness or structural abnormalities.
Area of Science:
- Cardiology
- Internal Medicine
- Echocardiography
Background:
- Hypertension and unstable angina are common cardiovascular conditions.
- Left ventricular diastolic (LVD) function is crucial for cardiac health.
- Understanding LVD dysfunction in combined conditions is clinically important.
Purpose of the Study:
- To investigate left ventricular diastolic (LVD) function in hypertensive patients experiencing unstable angina.
- To compare LVD function in hypertensives with unstable angina (HTU) against normotensives with unstable angina (NTU) and uncomplicated hypertensives (HT).
Main Methods:
- Echocardiography was used to assess LVD function via transmitral valve Doppler flow (E/A ratio).
- Left ventricular mass indexed to body surface area (LVM/S) was calculated using the Penn-Cube formula.
- Statistical analysis included the Mann-Whitney test, with significance set at P < .05.
Main Results:
- The HTU group showed a significantly lower E/A ratio (0.8) compared to NTU (1.17) and HT (1.1) groups, indicating LVD dysfunction (P = .037 and .049).
- Left ventricular mass indexed to body surface area (LVM/S) was higher in the HTU group versus the HT group (P = .017), but not significantly different from the NTU group.
- Significant LVD dysfunction was observed in hypertensive patients with unstable angina, irrespective of LVM and ischemia.
Conclusions:
- Hypertensive patients with unstable angina present with significant left ventricular diastolic dysfunction.
- This dysfunction appears independent of left ventricular mass and ischemic burden.
- Potential causes include increased left ventricular stiffness or structural abnormalities.
Abstract:
The present study was performed to investigate left ventricular diastolic (LVD) function in hypertensive patients with unstable angina. Three groups of 17 patients each were studied. Group 1 consisted of hypertensives with unstable angina (HTU); group 2, normotensives with unstable angina (NTU); and group 3, untreated, uncomplicated hypertensives (HT). The LVD function was assessed echocardiographically by transmitral valve Doppler flow to measure the ratio between the early diastolic filling (E) and the atrial contraction phase (A). An E/A ratio of < 1 was suggestive of LVD dysfunction. Left ventricular mass (LVM), from an M-mode echocardiogram using the Penn-Cube formula, was corrected to body surface area (LVM/S) using a standard nomogram. Data are represented as median values and analyzed by Mann-Whitney test. P was significant at < .05. The HTU group had an E/A ratio of 0.8, and the NTU and HT groups had ratios of 1.17 and 1.1, respectively. There was significant diastolic dysfunction in the HTU group compared with the NTU and HT groups (P = .037 and .049, respectively). Although the LVM/S was significantly higher in the HTU group when compared with the HT group (110.6 and 96.9, respectively, P = .017), there was no significant difference between the HTU and NTU groups (123.1), P = .67. Hypertensive patients with unstable angina have significant LVD dysfunction that seems to be independent of LVM and ischemia. This may be attributable to increased stiffness of the left ventricle or structural left ventricular abnormalities.