Arterial hypertension was associated with prolonged isovolumic relaxation time (103 vs 78 ms, P<0.0001) and reduced midwall shortening (16.9% vs 17.8%, P<0.02) compared to normotensive controls.
Cross-Sectional (n=324)
Are left ventricular diastolic properties impaired independently of systolic dysfunction in patients with arterial hypertension?
Diastolic abnormalities in hypertensive patients can occur before systolic dysfunction and are independently related to impaired midwall shortening, even when ejection fraction is normal or supranormal.
Absolute Event Rate: 103% vs 78%
p-value: p=<0.0001
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 (44+/-11 years, 78 obese, 96 women) and 165 normotensive subjects (32+/-11 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 hypertensive (66. 6+/-5.2%) than in normotensive (63.9+/-4.4%, P<0.0001) subjects, whereas midwall shortening (MS) was lower (hypertensive patients 16. 9+/-2.0%, normotensive subjects 17.8+/-2.2%, P<0.02), even after correction for end-systolic wall stress (P<0.05). Isovolumic relaxation time (IVRT) was greater in hypertensive patients (103+/-14 ms) than in normotensive subjects (78+/-19 ms), as was deceleration time of E velocity and peak A velocity (all P<0.0001). In multivariate analysis, IVRT was unrelated to EF, but a negative relation was found with MS (P<0.001), independent of age, BMI, presence of arterial hypertension, LV geometry, and load (multiple R(2)=0.58). 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 (P<0.005). 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.
Simone et al. (Tue,) conducted a cross-sectional in Arterial Hypertension (n=324). Arterial hypertension vs. Normotensive subjects was evaluated on Isovolumic relaxation time (IVRT) (p=<0.0001). Arterial hypertension was associated with prolonged isovolumic relaxation time (103 vs 78 ms, P<0.0001) and reduced midwall shortening (16.9% vs 17.8%, P<0.02) compared to normotensive controls.