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Abstract
Hypertensive left ventricular hypertrophy(LVH) was considered to be a physiologic adaptation to the increased afterload of left ventricle, but recent studies revealed that LVH was one of the most important target organ damage in essential hypertensive patients & cardiovascular morbidity was increased in patients with hypertensive LVH. Hypertensive LVH could be classified into three types : concentric LVH, disproportionate septal thickening(DST), and left ventricular dilatation. Relatively high incidence of DST in hypertension has bee reported after clinical introduction of echocardiogram. But, the mechanisms for the development of DST and its clinical significance have not been elucidated exactly.
In order to assess left ventricular diastolic function in hypertensives with DST, the authors performed phonocardiogram, M-mode, and pulsed Doppler echocardiogram in 15 normotensive control(group A : 5 male, 10 female, 44.4±7.7 years), 15 hypertensives without LVH(group B : 5 male, 10 female, 45.5±8.6 years), 85 hypertensives with DST(group C : 9 male, 16 female, 47.5±8.6 years) and 15 hypertensives with concentric LVH(group D : 8 male, 7 female, 47.7±6.1 years).
The obtained results were as follows :
1) Left ventricular ejection fraction was 71.6±6.3% in group A, 71.9±7.5% in group B, 731±7.0% in group C, and 70.3±10.3% in group D. Ejection fraction was not significantly different in each other group.
2) Left ventricular mass index(LVMI) by echocardiogram was 87.8±20.6g/m2 in group A, 106.2±13.4g/m2 in group B, 139.1±28.1g/m2 in group C, and 167.7±41.4g/m2 in group D. Mean of LVMI was above 125g/m2 in group C and D.
3) OR slope posterior aortic root M-Mode echocardiogram was 4.58±1.02cm/sec in group A, 3.99±1.25cm/sec in group B, 3.15±0.95cm/sec in group C, and 3.44±0.714cm/sec in group D. OR sloped of group C and D were significantly decreased compared to that of group A(p<0.001, p<0.01 respectively), and OR slope of group C was significantly decreased compared to that of group B(p<0.05).
4) Left ventricular isovolumic relaxation time by A2D time was 63±12.2msec in group A, 102±29.7msec in group B, 11±27.2msec in group C, and 97±23.6msec in group D. A2D times of group B, C and D were significantly prolonged compared to that of group A(p<0.001 respectively).
5) Mitral valvular peak Doppler folw wave velocity ratio[E/A(v)] was 1.42±0.45 in group A, 0.97±0.26 in group B, 0.93±0.39 in group C, and 1.01±0.32 in group D. D/A(v)'s of group B, C and D were significantly decreased compared to that of group A(p<0.01 respectively).
6)Mitral valvular Doppler flow wave area ratio[E/A(a)] was 2.22±0.82 in group A, 1.62±0.54 in group B, 1.58±0.87 in group C, and 2.07±1.22 in group D. D/A(a)'s of group B and C were significantly decreased compared to that of group A (p<0.05 respectively).
7) Early diastolic deceleration rate(EDDR) of mitral valvular flow wave was 8.25±3.21m/sec2 in group A, 6.99±1.20m/sec2 in group B, 6.27±2.02m/sec2 in group C, and 5.90±2.17m/sce2 in group D. DEER's of group C, and D were decreased significantly compared to that of group A(p<0.05 respectively).
8) Early diastolic deceleration time(EDDT) of mitral valvular Doppler flow wave was 144±42.9msece in group A, 144±28.6msec in group B, 151±42.0msec in group C and 170±41.7msec in group D. EDDT of group D was significantly prolonged compared to that of group A(p<0.00).
Above results suggest that left ventricular diastolic function may be impaired in the hypertensives with DST and normal systolic function. The nature of the dysfunction in DST was similar to that of the concentric hypertrophy but the decreases of E/A area ratio and OR slope were more prominent in DST group.
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