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Left ventricular systolic and diastolic function assessed with two-dimensional and doppler echocardiography in "white
1Department of Medicine, Section of Cardiology, University Hospital of Trondheim, Norway.
Insights
White coat hypertension, characterized by elevated office blood pressure, increases left ventricular external work and end-systolic wall stress. However, key measures like ejection fraction remain normal in these individuals.
Area of Science:
- Cardiology
- Hypertension Research
- Echocardiography
Background:
- The "white coat" phenomenon, where blood pressure is elevated in a clinical setting but normal outside, may impact cardiac function.
- Understanding this effect is crucial for accurate heart disease research and patient management.
Purpose of the Study:
- To investigate left ventricular (LV) function in individuals with white coat hypertension (WCH).
- To determine if the transient pressure increase in WCH affects LV mechanics and filling patterns.
Main Methods:
- Utilized two-dimensional and Doppler echocardiography along with calibrated subclavian arterial pulse tracing.
- Assessed LV function variables in 26 subjects with WCH and 32 normotensive controls.
Main Results:
- Subjects with WCH exhibited higher systolic blood pressure during echocardiography compared to their ambulatory readings.
- Increased left ventricular external work and end-systolic wall stress were observed in the WCH group.
- Alterations in left ventricular filling patterns were noted, specifically in mitral and pulmonary venous flow dynamics.
Conclusions:
- The arterial pressure response in WCH is linked to augmented LV external work and end-systolic wall stress.
- Despite these changes, ejection fraction and velocity of circumferential fiber shortening remain within normal limits in WCH.
- WCH is associated with specific alterations in LV filling, suggesting a subclinical impact on cardiac function.
Objectives:
The aim of this study was to investigate left ventricular function in subjects with "white coat" hypertension, defined as office arterial diastolic pressure > or = 90 and ambulatory daytime pressures < 140/90 mm Hg.
Background:
The white coat arterial pressure response may, by influencing left ventricular function, have a confounding effect in studies of heart disease.
Methods:
Two-dimensional and Doppler echocardiography combined with the calibrated subclavian arterial pulse tracing, were used to assess variables of left ventricular function in 26 subjects with white coat hypertension (office arterial diastolic pressure > or = 90 and < 115 mm Hg and ambulatory daytime diastolic pressure > or = 90 mm Hg) and 32 normotensive subjects.
Results:
In subjects with white coat hypertension, systolic arterial pressure during the echocardiographic examination was significantly higher than ambulatory daytime systolic pressure. This pressure response was positively related to the ratio of the systolic to diastolic pulmonary venous flow peak velocities and to the peak velocity of flow reversion during atrial systole; it was inversely related to the ratio of early to late mitral flow peak velocities. Left ventricular stroke volume, ejection fraction and velocity of circumferential fiber shortening did not differ in the study groups, but left ventricular external work and end-systolic wall stress were increased in the white coat group.
Conclusions:
The arterial pressure response in subjects with white coat hypertension is associated with increased left ventricular external work, increased end-systolic wall stress and alterations of left ventricular filling but normal ejection fraction and velocity of circumferential fiber shortening.