J Korean Soc Echocardiogr.  1996 Jul;4(1):47-56. 10.4250/jkse.1996.4.1.47.

Diastolic Function Evaluation in Systemic Arterial Hypertension : A Color M-mode Doppler and Doppler Echocardiographic Analysis

• Her SH
• Kim KS
• Hur KC
• Han SW
• Hyun DW
• Shin KM
• Kim YN
• Kim KB

• KMID: 2410405
• DOI: http://doi.org/10.4250/jkse.1996.4.1.47

Abstract

BACKGROUND
Several recent studies have demonstrated that left ventricular diastolic dysfunction is major cause of congestive heart failure and may precede systolic dysfunction or without left ventricular hypertrophy in most patients with systemic arterial hypertension. The purpose of this study is to evaluate left ventricular diastolic function in patients with systemic arterial hypertension compared with normal control group using color M-mode Doppler and Doppler echocardiographic studies.
METHODS
From October 1994 to August 1995. 53 patients(18 men and 35 women, mean age : 56.1±12.6 years) with essential hypertension and 30 subjects age-matched nomal controls(13 men and 17 women, mean age 55.9±12.3 years) were included in this study. We measured the early propagation slope of LV inflow by color M-mode Doppler Echocadiography and the peak velocities of E and A wave, E/A tatio, deceleration time of E wave, isovolumic relaxation time by Doppler echocardiography. We also studied left ventricular diastolic function in patients with hypertension who were divided two group(Group I : hypertension with left ventricular hypertrophy, Group II : hypertension without left vetricular hypertrophy).
RESULTS
1) Early propagation slope of LV inflow was significantly decreased in patients with hypertension compared with normal control group(57.43±17.15m/secs vs 69.87±12.71m/secs, p < 0.05). 2) Peak velocity of A wave and isovolumic relaxation time were significantly increased in patients with hypertension compared with normal control group(0.79±0.2m/sec vs 0.69±0.17m/sec, 132.96±36.98m/secs vs 108.67±23.30m/secs, p < 0.05), whereas E/A ratio was significantly decreased in patients with hypertension compared with normal control group(0.96±0.42 vs 1.18±0.43, p < 0.05). Peak velocity of E wave and deceleration time of E wave were not significantly different between in patiens with hypertension and normal contral group, but peak velocity of E wave was showed decreasing tendency in patients with hypertension compared with normal contral group(0.75±0.38m/sec vs 0.77±0.17m/sec, p>0.05), whereas deceleration time of E wave was showed increasing tendency in patients with hypertension empared with normal control group(196.57±37.07m/secs vs 189.33±41.35m/secs, p>0.05). 3) Early propagation slope of LV inflow was not significantly different between Group I and Group II, but showing decreasing tendency in Group I compared with Group II(54.72±14.65m/sec vs 60.16±18.96m/sec, p>0.05). Peak velocity of E wave and peak velocity of A wave and E/A ratio and deceleration time were not significantly different between Group I and Group II but peak velocity of E wave and E/A ratio were showed decreasing tendency in Group I(0.65±0.19m/sec vs 0.73±0.22m/sec, 0.86±040 vs 1.04±0.44, p>0.05), whereas peak velocity of A wave and deceleration time of E wave were showed increasing tendency in Group I(0.80±0.20m/sec vs 0.74±0.18m/sec, 199.38±46.45m/secs vs 196.89±24.76m/secs, p>0.05). Only isovolumic relaxation time was significatly increased in Group I compared with Group II(150.63±44.75m/secs vs 120.34±19.77m/secs, p < 0.05).
CONCLUSION
Left ventricular diastolic dysfunction may precrede systolic or without left ventricular hypertrophy in patients with systemic arterial hypertension. An early diagnosis of left ventricular diastolic dysfunction, color M-mode Doppler echocardiography and Doppler echocardiography were useful diagnostic stools.

Keyword

Diastolic Dysfunction; Color M-mode doppler echocardiography; Hypertension

MeSH Terms

Deceleration
Early Diagnosis
Echocardiography*
Echocardiography, Doppler
Female
Heart Failure
Humans
Hypertension*
Hypertrophy, Left Ventricular
Male
Relaxation

Figure

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  Fig. 1. Shematic illustration of the levels used for analysis of left ventricular filling. The heart was shown in the apical 4-chamber view.

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  Fig. 2. Early flow propagation slope of LV inflow(arrows) was shown as a linear segment of early filling flow from mitral opeing to LV apical region and was defined as a border of red to yellow color change using color M-mode Doppler echocardiography.

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  Fig. 3. Comparison of early flow propagation slope of E wave using color M-mode Doppler echocardiography between the patients with hypertension and normal control group.

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  Fig. 4. Comparison of peak velocities(Vmax) of E & A waves(A) and E/A ratio(B) using Doppler echocardiography between the patients with hypertension and normal control group.

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  Fig. 5. Comparison of deceleration time(DT) of E wave and isovolumic relaxation time(IVRT) using Doppler echocardiography between the patients with hypertension and normal control group.

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  Fig. 6. Comparisom of LV diastolic dimension(LVDd), LV systolic dimension(LVDs), interventricular septum (IVS), LV posterior wall(LVPW) and LA dimension (LAD) using two-dimensional echocardiography between the patients with hypertension and normal control group.

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  Fig. 7. Comparison of LV ejection fraction(LVEF), LV mass index(LVMI) using two-dimensional echocardiography between the patients with hypertension and normal control group.

Reference

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