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[Effect of infusion of hyperosmolar mannitol on left ventricular function in essential hypertension]
J Pechán1, P Povinec, E Bránska
1Oddelenie nukleárnej Medicíny 1. internej kliniky Lekárskej fakulty Univerzity Komenského a Fakultnej nemocnice v Bratislave.
Insights
Essential hypertension (EH) patients in stage II show subclinical left ventricular diastolic and systolic dysfunction. Mannitol infusion reveals these issues, aiding diagnosis and treatment for better cardiovascular health.
Area of Science:
- Cardiology
- Cardiovascular Physiology
- Nuclear Cardiology
Background:
- Essential hypertension (EH) is a prevalent condition affecting cardiovascular health.
- Left ventricular (LV) function is crucial for maintaining cardiac output.
- Early detection of LV dysfunction in EH is vital for timely intervention.
Purpose of the Study:
- To assess global and regional left ventricular function in patients with essential hypertension.
- To evaluate the impact of hyperosmolar mannitol infusion on LV function in hypertensive patients.
- To identify subclinical cardiac dysfunction in early-stage essential hypertension.
Main Methods:
- Equilibrium-radionuclide ventriculography (ERNV) was used to assess LV function.
- 40 patients with EH (20 stage I, 20 stage II) and 18 normotensives were studied.
- LV function was evaluated at rest and after intravenous mannitol infusion.
Main Results:
- At rest, no significant differences in global LV function were observed between normotensives and hypertensive groups.
- Stage II EH patients showed significantly lower global ejection fraction (GEF), peak ejection rate (PER), and peak filling rate (PFR) compared to stage I.
- Mannitol infusion improved GEF and PFR in normotensives and stage I EH, but not in stage II EH, revealing subclinical diastolic and systolic dysfunction.
Conclusions:
- Hyperosmolar mannitol infusion effectively uncovers subclinical left ventricular diastolic and systolic dysfunction in stage II essential hypertension.
- This diagnostic approach is valuable for identifying early cardiac changes in hypertensive patients.
- Early detection facilitates targeted treatment strategies to prevent cardiovascular complications.
Abstract:
The left ventricular function of the heart was examined by means of the method of equilibrium-radionuclide ventriculography in 40 patients with essential hypertension (EH)--20 patients in stage I (H1), 20 patients in stage II (H2) according to WHO criteria--and in 18 normotensives (N). The examination was performed at rest and immediately after stress by intravenous infusion of hyperosmolar mannitol. At rest, the parameters of global systolic and diastolic functions of the left ventricle in normotensives do not differ significantly from the values in both groups of hypertensives. The global ejection fraction (GEF), peak ejection rate (PER) and peak filling rate (PFR) were in H2 significantly lower than in H1. Sectorial ejection fraction (SEF) in the apicoseptal area is in H2 significantly lower than H1 and N. After infusion of hyperosmolar mannitol the GEF and PFR increased in N and H1 only. When comparing all groups after infusion of mannitol the PFR in H2 is significantly lower also in comparison with N with the tendency (significant limit) to lower values of GEF and PER. PER and PFR were significantly lower and the end-diastolic volume (EDV) was significantly higher in H2 in comparison with H1. SEF was significantly lower in H2 in comparison with N in 3 out ot 9 sectors and in comparison with H1 in 8 out of 9 sectors. The infusion of hyperosmolar mannitol reveals subclinical disturbances of the diastolic and partially also of the systolic function of the left ventricle in stage II of EH which is very useful for diagnosis and treatment. (Tab. 4, Fig. 3, Ref. 22.).