The evaluation of left ventricular diastolic function by tissue Doppler echocardiography in essential hypertension

Abstract

To evaluate Left ventricular(LV) diastolic function in essential hypertension by conventional pulse-wave Doppler echocardiography (cPWD) and Doppler tissue imaging (DTI) and compare the two modalities. Two hundred patients with essential hypertension were classified as NLVH subgroup (n = 160) and LVH subgroup (n = 40) based on left ventricular mass index (LVMI) with one hundred and sixty health subjects as control group. The mitral valve flow pattern (MVFP) was obtained.Early diastolic (E) and late velocities (A) were measured and E/A was calculated. DTI was used to obtain the left ventricular lateral wall early diastolic mitral annulus velocity (Em) and E/Em was calculated. Essential hypertension patients had LV diastolic dysfunction both by cPWD (higher E and lower E/A ratio) and DTI (lower Em and higher E/Em ratio) compared with healthy subjects [E: (0.88 ± 0.18) cm/s vs (0.76 ± 0.19) cm/s; E/A ratio: 0.86 ± 0.28 vs 1.02 ± 0.38; Em: (9.4 ± 2.8) cm/s vs (11.9 ± 3.8) cm/s; E/Em ratio: 7.9 ± 2.7 vs 6.0 ± 1.8: with all P value < 0.01]. Em was significantly reduced and E/Em was significantly elevated in LVH subgroup than NLVH subgroup [Em: (7.7 ± 2.6) cm/s vs (9.9 ± 2.8) cm/s, E/Em:9.6 ± 3.6 vs 7.4 ± 2.4, P < 0.05]. No significant difference was found in A and E/A between these two subgroups [(0.90 ± 0.22) cm/s vs (0.87 ± 0.17) cm/s; 0.80 ± 0.34 vs 0.88 ± 0.28, P > 0.05]. cPWD and DTI both had implications to detect diastolic dysfunction in non-hypertrophic stage hypertension. Em, E/Em could be more sensitive and precise to reflect the impairment of diastolic function in the progress of hypertension.