PS-BPC05-10: DIASTOLIC DYSFUNCTION, HYPERTROPHY AND HYPERTENSION VENTRICULAR-ARTERIAL UNCOUPLING TREATMENT

Abstract

Objective: the aim of this study was to evaluate the effects of hypertension ventricular-arterial uncoupling treatment on left ventricular hypertrophy and diastolic dysfunction regression. Design and method: observational prospective study, consecutive hypertension patients. Left ventricle mass index measured by Devereux 2D echocardiography method and diastolic function by conventional and tissue Doppler following the Guidelines from Echocardiography from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Left ventricular end systolic elastance (Ees) was measured by Guarracino calculator, the effective arterial elastance (Ea) and ventricular-arterial coupling (VAC) measured by Sunagawa et al single beat method adapted by Chen et al in human ventricles. The sample was analyzed in quartiles (Q) according to VAC (Q1 worst VAC to Q4 best VAC). Follow-up 2 years. Results: 288 patients, mean age 56.3 + 12.5 years and 168 patients (58.3%) males. VAC increased from 0.303 + 0.07 to 0.54 + 0.25 (p < 0.005) in Q1 mainly due to a reduction in Ees from 5.25 + 2.3 to 3.68 + 0.25 mm Hg/ml (p < 0.01) while Ea increased from 1.5 + 0.53 to 1.64 + 0.56 mm Hg/ml (p = NS); on the other side VAC was reduced from 0.87 + 0.15 to 0.68 + 0.26 (p < 0.05) in Q 4 with an increase in Ees from 2.28 + 0.6 to 2.67 + 1.07 mm Hg/ml (p = NS) and a reduction of Ea from 1.94 + 0.41 to 1.69 + 0.67 mm Hg/ml (p = NS) (Figure). The frequency of LVH was reduced from 31.9% to 10.8% in Q1 (p < 0.025) while moved from 14.7 to 17.9% (p = NS) in Q2, 22.9% to 13.9% (p = NS) in Q3 and 11.3 % to 23.7% (p = NS) in Q4. The frequency of normal diastolic function increased from 75% to 94.6% (p < 0.01) in Q1, from 78.7% to 100% in Q2 (p < 0.005), from 87.1% to 100% (p < 0.025) in Q3 and from 88.7% to 100% (0,025) in Q4. Conclusions: 1) patients with the worst ventricular-arterial uncoupling (Q1) are the most VAC benefited from hypertension treatment; 2) regression of left ventricular hypertrophy was observed only in the group of patients with the worst ventricular-arterial uncoupling (Q1); 3) improvement in diastolic function was demonstrated in all Q of ventricular-arterial coupling. This study shows that achieving an optimal mechanical efficiency measured as ventricular-arterial coupling by hypertension treatment is essential for left ventricular hypertrophy and diastolic dysfunction regression.