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Role of left ventricular hypertrophy in diastolic dysfunction in aged hypertensive patients
M Zabalgoitia1, S N Ur Rahman, W E Haley
1Department of Medicine/Cardiology, University of Texas Health Science Center at San Antonio, USA.
Insights
Left ventricular hypertrophy (LVH) does not independently affect diastolic dysfunction in older hypertensive patients. Impaired relaxation is the main issue, worsening with age.
Area of Science:
- Cardiology
- Geriatrics
- Hypertension Research
Background:
- Diastolic dysfunction is common in older hypertensive patients.
- Left ventricular hypertrophy (LVH) is a frequent finding in hypertension.
- The specific impact of LVH on diastolic patterns in aging hypertensive populations requires clarification.
Purpose of the Study:
- To investigate the association between left ventricular hypertrophy (LVH) and diastolic dysfunction patterns.
- To assess the influence of LVH on mitral flow velocities and patterns in older adults with essential hypertension.
Main Methods:
- Doppler echocardiography was performed on 665 patients (aged 55-80 years) with mild-to-moderate essential hypertension.
- Analysis included left ventricular dimensions, mass index, and mitral flow parameters (E/A ratio, deceleration time).
- Patients were categorized by age and diastolic function patterns (normal, impaired relaxation, restrictive).
Main Results:
- The prevalence of sex-adjusted LVH was 65%.
- No significant differences in mitral flow velocities or diastolic patterns were observed between hypertensive patients with and without LVH.
- Impaired relaxation was the predominant diastolic dysfunction pattern, increasing with age (73% in 50s, 83% in 60s, 88% in 70s).
Conclusions:
- LVH is not an independent predictor of abnormal diastolic flow patterns in older hypertensive patients with preserved systolic function.
- Impaired relaxation is the primary pattern of diastolic dysfunction in this population.
- Diastolic dysfunction, particularly impaired relaxation, significantly worsens with advancing age.
Objective:
To evaluate the influence of left ventricular hypertrophy (LVH) on the diastolic dysfunction in older hypertensive patients.
Methods:
In total 665 patients (58% men, 61% White, aged 55-80 years) with mild-to-moderate essential hypertension underwent Doppler echocardiography. Data included left ventricular dimensions, left ventricular mass index, body mass index, E- and A-wave mitral flow velocities, E:A ratio, deceleration time > 150 ms), impaired relaxation (E:A ratio < 1.0, prolonged deceleration time according to age), and restrictive physiology (E:A ratio > 2.1, deceleration time < 150 ms)]. Data were distributed according to age (50-59, 60-69, and 70-80 years).
Results:
The overall prevalence of sex-adjusted LVH in this study was 65%. When we compared hypertensive patients with and without LVH, the E- and A-wave velocities, E:A ratio, and deceleration time were similar. Moreover, the prevalences of normal, impaired relaxation, and restrictive physiology patterns among patients with and without LVH did not differ significantly (20, 79.5, and 0.5 versus 24, 75.5, and 0.5%). When the mitral flow patterns were adjusted according to age, the impaired relaxation pattern increased further with age (to 73% during the fifth decade, 83% during the sixth decade, and 88% during the seventh decade).
Conclusions:
LVH is not an independent factor associated with abnormal flow patterns in hypertensive patients aged over 50 years with normal systolic contractility. The impaired relaxation is the predominant pattern of diastolic dysfunction in older hypertensive patients and increases further with aging.