510 Role of Doppler tissue imaging in the assessment of diastolic dysfunction in hypertensive patients with and without concentric geometric remodeling

Abstract

It has been shown that in patients with essential hypertension and cardiac hypertrophy Tissue Doppler Imaging (TDI) is able to detect impairment of diastolic function more accurately than pulsed transmitralic Doppler (TD). The aim of this study was to assess if, in hypertensive patients without cardiac hypertrophy, there are differences in diastolic function evaluated by using TDI or TD. We studied 17 patients (46±9 years, 11 male) with never treated essential hypertension. Echocardiographic evaluation was used to assess the following parameters: concentric remodelling (CR) pattern, defined as a normal left ventricular mass index with a relative wall thickness >0.45; global diastolic dysfunction (GDD), detected by correcting for age the TD flow early to atrial (E/A) ratio values; regional diastolic dysfunction (RDD) evaluated by TDI, with the sample volume positioned within the basal septum and defined according to the age-corrected tissue E/A ratio values. CR was found in 12 patients (70%); among these, 4 showed both GDD and RDD, while 5 patients showed only RDD. In the absence of CR, no patient showed either GDD or RDD. At Fisher test analysis, RDD was significantly associated with the presence of CR (p=0.019), whereas no significant association was found between CR and GDD. TDI showed a higher sensitivity in detecting diastolic dysfunction than TD (75% vs 33%) and a higher negative predictive value (63% vs 38%); both TDI and TD had a specificity and positive predictive value of 100%. In conclusion, in hypertensive patients with cardiac remodeling an abnormal regional diastolic function can be observed more frequently than a global diastolic dysfunction, thus suggesting that TDI is able to detect early impairment of diastolic function more accurately than pulsed transmitralic Doppler even in the absence of cardiac hypertrophy.