Abstract
Our aim was to investigate the changes in the myocardium stiffness index for patients suffering from systemic hypertension, and to assess their left ventricular performance. We studied 263 hypertensive patients and 166 healthy subjects as a control group. By using conventional Doppler echocardiography, the following parameters were measured—Left ventricular end diastolic diameter, left ventricular end systolic diameter, transmitral early velocity, isovolumic relaxation time, and isovolumic contraction time. Tissue Doppler imaging (TDI) was used in the measurements of the early mitral annular velocity (Ea) and the diastolic stiffness was obtained by calculating the ratio E\Ea\LVIDd. Index myocardial performance (IMP) was calculated according to following equation (IVCT + IVRT)/ET for both the control group and hypertensive group. Results reveal that the differences in the average value of transmitral early filling velocity (E) between patients and control groups for age range (20 - 49) and (50 - 80) were (𕒵.91%) and (𕒷.69%) respectively with p value >0.05 for both groups, and the changes in LVIDd between patients and control groups were 0.42% and 1.29% for age ranges (20 - 49) and (50 - 80) respectively with p value >0.05 for both age groups. A significant difference in IMP between patients and controls has also been observed and the changes were 29.54% and 30.43% for age range (20 - 49) and (50 - 80) respectively with p value 0.05) for both age groups. In conclusion, LV myocardial diastolic stiffness index and IMP are increased in hypertensive patients.
Highlights
Hypertensive heart disease is defined as the response of the heart to afterload imposed on the left ventricle by the progressively increasing arterial pressure and total peripheral resistance produced by hypertensive vascular disease [1]
Whether left ventricular (LV) diastolic dysfunction is caused directly by raised blood pressure or by structural changes related to LV hypertrophy remains controversial but hypertensive patients may present with normal transmitral inflow filling patterns or with the more typical presentation of diastolic dysfunction [3]
The higher A wave may be caused by less blood volume transferred to the LV during the E wave which may be caused by the decrease in suction during early diastole, the left atrial to left ventricular (LV-LA) pressure gradient at the time of mitral valve opening is decreased [18], and to the fact that most of the transmitral blood filling for the LV is attributed to E wave rather than A wave, so in order to compensate the lack of blood to the LV the late filling velocity A wave must increase more than what E wave decreases
Summary
Hypertensive heart disease is defined as the response of the heart to afterload imposed on the left ventricle by the progressively increasing arterial pressure and total peripheral resistance produced by hypertensive vascular disease [1]. Uncontrolled and prolonged elevation of BP can lead to a variety of changes in the myocardial structure, coronary vasculature, and conduction system of the heart. These changes in turn can lead to the development of left ventricular hypertrophy (LVH), coronary artery disease (CAD), and various conduction system diseases [2]. Doppler echocardiography is the most important clinical tool available for the diagnosis of diastolic dysfunction. Echocardiography is widely available, portable, and biologically safe and is capable of excluding other important causes of heart failure, such as valvular disease [4]
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