Relation of Left Ventricular Diastolic Properties to Systolic Function in Arterial Hypertension

Giovanni de Simone, Rosanna Greco, GianFrancesco Mureddu, Carmela Romano, Raffaele Guida, Aldo Celentano, Franco Contaldo
2000 Circulation  
Background-It is unclear whether impairment of left ventricular (LV) diastolic characteristics is independent of systolic dysfunction. Methods and Results-To address this issue, 159 consecutive hypertensive patients (44Ϯ11 years, 78 obese, 96 women) and 165 normotensive subjects (32Ϯ11 years, 84 obese, 110 women) were studied with the use of Doppler echocardiography. After adjustment for age, body mass index (BMI), and sex, we found that ejection fraction (EF; M-mode, z-derived) was higher in
more » ... ed) was higher in hypertensive (66.6Ϯ5.2%) than in normotensive (63.9Ϯ4.4%, PϽ0.0001) subjects, whereas midwall shortening (MS) was lower (hypertensive patients 16.9Ϯ2.0%, normotensive subjects 17.8Ϯ2.2%, PϽ0.02), even after correction for end-systolic wall stress (PϽ0.05). Isovolumic relaxation time (IVRT) was greater in hypertensive patients (103Ϯ14 ms) than in normotensive subjects (78Ϯ19 ms), as was deceleration time of E velocity and peak A velocity (all PϽ0.0001). In multivariate analysis, IVRT was unrelated to EF, but a negative relation was found with MS (PϽ0.001), independent of age, BMI, presence of arterial hypertension, LV geometry, and load (multiple R 2 ϭ0.58). For comparable age, sex distribution, BMI, and blood pressure values, hypertensive patients with lower afterload-adjusted MS exhibited longer IVRT than patients with normal MS (PϽ0.005). However, IVRT remained higher than in normotensive control subjects after control for LV geometry and load. Conclusions-Doppler indices of delayed LV relaxation can be detected in the presence of normal or supranormal EF but are independently related to impaired MS. A less severely abnormal relaxation, however, can be also detected in the presence of normal midwall function, independent of LV geometry and load. Thus, diastolic abnormalities may occur before systolic dysfunction even when it is measured at the midwall. (Circulation. 2000;101:152-157.)
doi:10.1161/01.cir.101.2.152 pmid:10637202 fatcat:7mhpbrxpijh37goh63r6j3xfri