Aggravation of left ventricular diastolic dysfunction in hypertensives with coronary artery disease

Abstract

We investigated the combined effects of hypertension and coronary artery disease (CAD) on left ventricular (LV) diastolic function. We examined 118 consecutive hypertensives who underwent diagnostic coronary angiography. All patients underwent a complete echocardiographic study within 24 h of catheterization by operators blind to their condition. The study participants were divided into two groups according to the presence of CAD: group A, with the disease (n=72); and group B, without (n=46). Patients with CAD exhibited lower LV fractional shortening and ejection fraction (P=0.002 and P=0.001). Hypertensives with CAD had significantly prolonged isovolumic relaxation time (IVRT) compared to those without CAD (P<0.001). Most interestingly, CAD patients had significantly worse Ema/Ama, Vp (flow propagation velocity), E/Vp and Vp/IVRT (all P<0.05). In addition, after adjusting for confounders, univariate and multivariate logistic regression analyses revealed that IVRT increases were associated with greater odds of CAD, whereas decreases in Vp or Vp/IVRT were associated with lower odds of CAD (all P ≤ 0.001). In hypertensives, the early recognition of LV diastolic performance alteration may be associated with the presence of significant CAD, indicating the need for more aggressive approaches both in terms of pharmacological treatment and interventional evaluation.