Comparison of Echocardiographic Measures of Left Ventricular Diastolic Function in Early Hypertension

doi:10.1016/j.amjcard.2007.07.029

The American Journal of Cardiology

Volume 100, Issue 12, 15 December 2007, Pages 1771-1775

https://doi.org/10.1016/j.amjcard.2007.07.029 Get rights and content

Left ventricular (LV) diastolic dysfunction identifies patients at risk of developing heart failure and may be common in patients with hypertension. The prevalence of LV diastolic dysfunction in patients with newly diagnosed hypertension was compared using criteria provided by the Canadian Consensus, European Study Group, and American Medical Association guidelines. One hundred twenty patients with newly diagnosed untreated hypertension (mean age 46.9 ± 2.1 years; 62 men, 58 women) with increased blood pressure (clinic >140/90 mm Hg, daytime ambulatory >135/85 mm Hg) underwent comprehensive 2-dimensional echocardiography. Transmitral inflow velocities were measured using pulse-wave Doppler with and without Valsalva’s maneuver, and a comprehensive assessment of tissue Doppler velocities was performed. The prevalence of LV diastolic dysfunction varied according to criteria used. There was a high prevalence of LV diastolic dysfunction (59%; n = 71) using Canadian Consensus guidelines; 27% of patients (n = 32) had a pseudonormal pattern unmasked using Valsalva’s maneuver and 32% (n = 39) had impaired relaxation at rest. Significantly fewer patients (10%; n = 12) had this diagnosis using European or American Medical Association guidelines (23%; n = 27). Using tissue Doppler imaging (early–late diastolic velocity ratio <1), the prevalence of LV diastolic dysfunction was 59% (n = 71), identical to findings using the Canadian Consensus guidelines. In conclusion, current national consensus guidelines defining LV diastolic dysfunction varied widely and underdiagnosed LV diastolic dysfunction in patients with newly diagnosed hypertension. Tissue Doppler imaging assessment is a rapidly and widely available tool that is as sensitive as the most stringent national guidelines and should be systematically incorporated into a more comprehensive assessment of LV diastolic dysfunction in this population.

Section snippets

Methods and Results

The study group was composed of 120 consecutive untreated Caucasian patients with hypertension (mean age 47 ± 2.1 years; 62 men, 58 women) from a tertiary referral clinic with inclusion criteria of clinic blood pressure >140/90 mm Hg on 3 occasions and >135/85 mm Hg daytime blood pressure recorded using an ambulatory monitor.⁴ Exclusion criteria were patients with secondary hypertension, LV hypertrophy unrelated to hypertension, coronary heart disease, heart failure, diabetes mellitus, atrial

Discussion

Using the available guidelines, we found a significantly higher prevalence of abnormalities with the Canadian (59%) rather than European (10%) or American Medical Association criteria (23%). These same 59% were correctly identified using TDI parameters alone. Such disparity in the reported incidence of LV diastolic dysfunction may extend beyond the hypertensive population. Using TDI, LV diastolic dysfunction was shown in 26% of unselected patients with hypertension or diabetes.⁷ In another

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The impact of hypertension on diastolic left ventricular function, evaluated by quantitative ECG-gated myocardial perfusion SPECT
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Citation Excerpt :
In the normotensive group (n = 11), HR, LVEDV, LVESV, LVEF, 1/3 MFR, PFR, and TTPF were comparable between after stress and at rest (HR 76.91 ± 7.9 b.p.m. vs. 76.91 ± 9.23 b.p.m., LVEDV 85.4 ± 27.9 ml vs. 86.4 ± 26 ml, LVESV 30 ± 13.6 ml vs. 30.2 ± 13.9 ml, 1/3 MFR 1.54 ± 0.3 EDV/s vs. 1.53 ± 0.36 EDV/s, PFR 2.9 ± 0.35 EDV/s vs. 2.92 ± 0.5 EDV/s, and TTPF 164.90 ± 36.39 ms vs. 158.91 ± 29.7 ms). Several studies have shown a high prevalence of LVDD in patients with hypertension (4,18–21) even in the absence of alteration of LV systolic function (22,23), including newly diagnosed patients who are clinically asymptomatic (24). Left ventricular diastolic dysfunction has been shown to be associated with increased cardiovascular morbidity and mortality, as well as the development of heart failure (25), thus rendering its recognition important for the assessment of hypertensive persons.
Abnormality of left ventricular (LV) diastolic function is frequently the earliest indicator of LV dysfunction in many diseases, including coronary artery disease (CAD), and hypertension. Electrocardiography (ECG)-gated technetium (Tc)-99 m tetrofosmin single-photon emission computed tomography (SPECT) has been reported to be a useful method for evaluation of LV function.
The purpose of this study was to assess the impact of hypertension on diastolic left ventricular function using ECG-gated Tc-99m tetrofosmin SPECT.
Thirty consecutive patients with normal exercise myocardial perfusion and normal LV systolic function, were studied out of 233 patients underwent ECG-gated Tc-99m tetrofosmin SPECT at our institution between January 2012 and December 2013. Patients were divided into two groups according to the presence or absence of systemic hypertension (blood pressure ⩾140/90 mm Hg on ⩾3 measurements or treatment with antihypertensive medication). Parameters of diastolic LV function were assessed.
Of the studied 30 patients, 19/30 (63%) had hypertension. There was no difference with respect to age, gender, LV end-diastolic volume (EDV), LV end-systolic volume (ESV), and LV ejection fraction values obtained by quantitative gated SPECT between patients with and without hypertension. The first-third mean filling rate (1/3 MFR), peak filling rate (PFR) of patients with hypertension (1.22 ± 0.38, 2.83 ± 1.10 EDV/s) were lower than those of patients without hypertension (1.54 ± 0.30, 2.90 ± 0.35 EDV/s), and the time to peak filling (TTPF) of patients with hypertension (199.42 ± 68.34 ms) was higher than TTPF of patients without hypertension (164.90 ± 36.39 ms).
Quantitative ECG-gated Tc-99m tetrofosmin SPECT reveals that hypertensive patients with preserved global LV systolic function may have significant changes in diastolic LV function. Gated myocardial perfusion SPECT reports are always lacking in these changes in diastolic function. We recommend inclusion of such changes in diastolic function in gated myocardial perfusion SPECT reports that can help in proper management of hypertensive patients.
Diastolic dysfunction in patients with type 2 diabetes mellitus: Is it really the first marker of diabetic cardiomyopathy?
2011, Journal of the American Society of Echocardiography
Diastolic dysfunction is considered the first marker of diabetic cardiomyopathy. However, preclinical systolic alteration was also recently described by strain, but its association with diastolic dysfunction has never been investigated.
One hundred fourteen patients with type 2 diabetes mellitus (DM) with controlled blood pressure and without overt heart disease were prospectively enrolled and compared with 88 age-matched controls. All subjects underwent comprehensive echocardiography, including diastolic evaluation according to current recommendations and speckle-tracking imaging. The prevalence of diastolic dysfunction, the determinants of diastolic parameters, and the association between preclinical systolic and diastolic dysfunctions were studied.
Diastolic parameters were altered in patients compared with controls, with lower E/A ratios, longer mitral deceleration and isovolumic relaxation times, and higher E/e′ ratio. Diastolic dysfunction occurred in 47% of patients with DM (33% and 14% with grade I and II diastolic dysfunction, respectively) and systolic alteration (longitudinal strain ≥ −18%) in 32% of patients. Whereas longitudinal systolic strain was independently associated with DM and gender, diastolic parameters were influenced by many factors, including age, rate-pressure product, history of hypertension, and body mass index. Systolic alteration occurred in 28% of patients with DM with normal diastolic function and in 35% with diastolic dysfunction.
Diastolic dysfunction diagnosed according to current recommendations is frequent in patients with DM but is also influenced by other factors. Systolic strain alteration may exist despite normal diastolic function, indicating that diastolic dysfunction should not be considered the first marker of a preclinical form of diabetic cardiomyopathy.
Predictive value of preoperative tissue Doppler echocardiographic analysis for postoperative atrial fibrillation after pulmonary resection for lung cancer
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Citation Excerpt :
The presence and severity of LV diastolic dysfunction are associated with an increased risk for first-time AF in patients with sinus rhythm.7,8 Older age, hypertension, female sex, diabetes and obesity, and LV hypertrophy have been reported as risk factors for diastolic heart failure.18 In addition, LV diastolic dysfunction has been frequently reported in patients with COPD.19,20
The objective of the present study was to evaluate the utility of tissue Doppler imaging for predicting the development of postoperative atrial fibrillation.
In this prospective observational study, we evaluated 126 patients with lung cancer who underwent a lobectomy during the 18-month period from August 2007 to January 2009. Preoperative evaluations for all patients included tissue Doppler imaging in addition to conventional echocardiographic analysis. The study end point was the development of postoperative atrial fibrillation.
Postoperative atrial fibrillation was identified in 29 (23%) patients, in whom significantly higher early transmitral velocity/tissue Doppler mitral annular early diastolic velocity values were noted compared with those seen in patients without atrial fibrillation (9.76 ± 2.3 vs 7.14 ± 1.7, P < .0001). The area under the receiver operating characteristic curve for early transmitral velocity/tissue Doppler mitral annular early diastolic velocity to predict postoperative atrial fibrillation after pulmonary resection for lung cancer was 0.83 (95% confidence interval, 0.74–0.92; P < .001). An early transmitral velocity/tissue Doppler mitral annular early diastolic velocity value of greater than 8 had a sensitivity of 90% and a specificity of 73% for predicting postoperative atrial fibrillation.
Postoperative atrial fibrillation after pulmonary resection might be associated with left ventricular diastolic dysfunction before surgical intervention revealed by using tissue Doppler imaging. Additional studies to establish the significance of tissue Doppler imaging as a tool to predict postoperative atrial fibrillation could contribute to improvements in lung cancer treatments.
Predictive value of B-type natriuretic peptide for postoperative atrial fibrillation following pulmonary resection for lung cancer
2010, European Journal of Cardio-thoracic Surgery
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2009, Neurology
The purpose of this study was to evaluate the relationship between cognitive performance, risk factors for cardiovascular and cerebrovascular disease (CVD), and HIV infection in the era of highly active antiretroviral therapy.
We evaluated the cognitive functions of men enrolled in the cardiovascular disease substudy of the Multicenter AIDS Cohort Study who were aged ≥40 years, with no self-reported history of heart disease or cerebrovascular disease. Results from comprehensive neuropsychological evaluations were used to construct composite scores of psychomotor speed and memory performance. Subclinical CVD was assessed by measuring coronary artery calcium and carotid artery intima-media thickness (IMT), as well as laboratory measures, including total cholesterol, fasting glucose, glycosylated hemoglobin, glomerular filtration rate (estimated), and standardized blood pressure and heart rate measures.
After accounting for education, depression, and race, carotid IMT and glomerular filtration rate were significantly associated with psychomotor speed, whereas IMT was associated with memory test performance. HIV serostatus was not significantly associated with poorer cognitive test performance. However, among the HIV-infected individuals, the presence of detectable HIV RNA in plasma was linked to lower memory performance.
These findings suggest that HIV infection may not be the most important predictor of cognitive performance among older gay and bisexual men in the post–highly active antiretroviral therapy era, at least among those with access to medical care and to appropriate medications. Medical factors associated with normal aging are significantly associated with performance on neuropsychological tests, and good clinical management of these factors both in HIV-infected individuals and those at risk for infection may have beneficial effects in the short term and could reduce the risk of subsequent cognitive decline.
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Systemic hypertensionComparison of Echocardiographic Measures of Left Ventricular Diastolic Function in Early Hypertension

Section snippets

Methods and Results

Discussion

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Soc Echocardiogr

J Am Coll Cardiol

Systemic hypertension
Comparison of Echocardiographic Measures of Left Ventricular Diastolic Function in Early Hypertension