Study for Left Ventricular Diastolic Dysfunction in the Hypertensive Patients by Pulsed Doppler Echocardiograpy

It is well known that the diastolic dysfunction of the left ventricle plays an important ole in the pathophysiology of heart failure in the various cardiac diseas. And many hypertensive patinents manifest diastolic dysfunction of the left ventricle in its early stage. Thus, early detection of left ventricular diastolic dysfunction has clinical importance in management and prognosis of hypertensive heart disease.

For the evaluation of the left ventricular diastolic function in the hypertensive patients, 30 normotensive control subject and 30 untreated essential hypertensive patients were studied by pulsed Doppler echocardiography at the left ventricular inflow, and then E/A velocity ratio [E/A (v)], early diastolic deceleration time(EDDT), and late diastolic time(LDT) were measured after confirming normal ejection fraction by M-mode echocardiography. The hypertensive patients were subgrouped according to the level of the diastolic pressure(Group A : mild, Group B: moderate, Group C: severe) and the each parameters of different groups were compared with those of the normal control group.

The result were as follows :

1) In the 30 noraml control group. ejection fraction was 69.4±4.6% and in the 30 hypertensive patients group, it was 66.7±5.3%. There was no significant differences between the normal control and the hypertensive patients group.

2) In the normal control group, E/A (v) was 1.54±0.32, EDDT was 147±13.4msec, LDT was 159±14.8 msec, and in all hypertensive patients group, mean E/A (v) was 0.80±0.38, mean EDDT was 165±19.4 msec, mean LDT was 149±14.9 msec. E/A (v) was significantly decreased(P<0.005) and EDDT was prolonged(P<0.025), compared with those of the normal control group, but there was no significant difference in LDT.

3) In Group A, E/A (v) was significantly decreased(0.98±0.36, P<0.005), compared with those of the normal control group, but there was no significant difference in EDDT(155±18.5 msec).

4) In Group B, E/A (v) was markedly decreased(0.76±0.45, P<0.005), and EDDT was significantly prolonged(170±24.8 msec, P<0.025), compared with those of the normal control group.

5) In Group C, E/A (v) was significantly decreased(0.66±0.32, P<0.005), and EDDT was prolonged(171±21.3 msec, P<0.01), compared with those of the normal control group.

Above results suggest that diastolic dysfunction of the left ventricle can precede the systolic dysfunction and clinical deterioration even in the mild hypertensive patients, and pulsed Doppler echocardiographic diastolic indices such as E/A (v) and EDDT play an important role in the early detection of the left ventricular diastolic dysfunction in the hypertensive patients.