Related Experiment Videos
Effects of reduced preload on diastolic filling in essential hypertensive patients with increased left ventricular
G Regolisti1, P Coghi, G Orlandini
1Laboratorio di Fisiologia Clinica, Istituto di Clinica Medica e Nefrologia, Universita di Parma, Italy.
Insights
Doppler diastolic filling indices remain unaffected by reduced preload in essential hypertensives with left ventricular hypertrophy. This finding is crucial for accurate hypertension assessment.
Area of Science:
- Cardiology
- Physiology
- Medical Imaging
Background:
- Doppler-derived diastolic filling indices are standard for evaluating essential hypertension.
- These indices can be influenced by loading conditions and systolic function.
- Left ventricular hypertrophy (LVH) is a common complication of hypertension.
Purpose of the Study:
- To assess transmitral flow patterns and left ventricular systolic function during acute preload reduction in hypertensive patients with LVH.
- To determine if Doppler diastolic indices are affected by decreased preload in this population.
Main Methods:
- Echocardiographic and Doppler evaluation of 9 essential hypertensives with LVH and 9 normotensive controls.
- Measurements taken at baseline and during lower body suction (-40 mm Hg) to reduce preload.
- Analysis of diastolic filling indices (e.g., acceleration time, deceleration time, peak velocity ratios) and systolic function parameters.
Main Results:
- Lower body suction similarly reduced end-diastolic volume index, stroke volume index, and midwall fractional shortening in both groups.
- Circumferential end-systolic stress remained unchanged.
- While some diastolic indices changed in normotensives, Doppler-derived diastolic filling indices were not significantly affected by preload reduction in hypertensives with LVH.
Conclusions:
- Doppler-derived diastolic filling indices are robust and not significantly altered by acute preload reduction in essential hypertensives with LVH.
- This suggests their reliability for assessing diastolic function in hypertensive patients even with altered loading conditions.
Abstract:
Doppler-derived indices of diastolic filling are widely used in the routine evaluation of essential hypertensives. However, these indices are affected by loading conditions and systolic performance. This study aimed at monitoring the transmitral flow pattern and indices of left ventricular systolic function during acute nonpharmacological isolated reduction of preload in essential hypertensives with left ventricular hypertrophy. Nine essential hypertensive patients with left ventricular hypertrophy and nine age- and sex-matched normotensive controls underwent echocardiographic and Doppler evaluation of both systolic function and diastolic filling indices at baseline and during lower body suction at -40 mm Hg. Lower body suction caused a similar decrease in end-diastolic volume index, stroke volume index, and midwall fractional shortening in the normotensives and hypertensives. Circumferential end-systolic stress was unaffected in both groups. Acceleration time of early diastolic filling and isovolumic relaxation time increased in the normotensives but not in the hypertensives. Deceleration time of early diastolic filling increased in both groups. The ratio of peak velocities during early filling and at atrial contraction decreased in the normotensives, whereas it was unchanged in the hypertensives; this was due to the fact that early filling velocity decreased in both groups, whereas peak velocity at atrial contraction decreased only in the hypertensives. We conclude that Doppler-derived diastolic filling indices are not affected by a reduction of preload in essential hypertensives with left ventricular hypertrophy.