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Ha, Chung, Lim, Kwan, Kim, Oh, Lee, Jang, Lee, Shim, Cho, and Kim: Doppler Echocardiographic Evaluation of Diastolic Function in Different Patterns of Ventricular Hypertrophy and Topography in Essential Hypertension
Original Article

J Korean Soc Echocardiogr 1995;3(2):168-178.

Published online: 18 February 1995

DOI: https://doi.org/10.3803/jkes.1995.3.2.168

Doppler Echocardiographic Evaluation of Diastolic Function in Different Patterns of Ventricular Hypertrophy and Topography in Essential Hypertension

Jong-Won Ha, M.D., Nam-Sik Chung, M.D., Sang-Wook Lim, M.D.∗∗, June Kwan, M.D., Ji-Young Kim, RDCS, Eun-Kyung Oh, RDCS, Moon-Hyoung Lee, M.D., Yang-Soo Jang, M.D., Young-Joon Lee, M.D., Won-Heum Shim, M.D., Seung-Yun Cho, M.D., Sung-Soon Kim, M.D.

Cardiology Division Yonsei Cardiovascular Center Yonsei University, Seoul, Korea

∗∗Department of Cardiology, Bundang Kyung Hee Cha Hospital, Sungnam, Korea

Copyright © 1995 Korean Society of Echocardiography

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Left ventricular hypertrophy and diastolic dysfunction have been well established in patients with essential hypertension. The left ventricular adaptation to hypertension represents a variety of spectrums with complex changes in topography. Left ventricular topography and diastolic and systolic function were evaluated in 48 patients with essential hypertension(group 1) and 33 age-matched normal controls(group 2) by transmitral inflow and pulmonary venous flow patterns assessed by Doppler echocardiography. The following Doppler parameters were measured: early(E) and late(A) peak velocities and velocity integrals, E/A ratio, deceleration time of E wave; systolic(S) and diastolic(D) peak velocities and velocity integrals of pulmonary venous flow, S/D ratio, and atrial reversal peak velocity.

Results

1) There were no siginificant differences of age, sex, heart rate, and body surface area between the two groups.
2) Systolic and diastolic blood pressures and left atrial dimension and left ventricular mass index and relative wall thickness were significandy increased in group 1. Deceleration time and isovolumic relaxation time were significandy increased in group 1(231.9 ± 47.6msecs vs 202.0 ± 40.7msecs, 106.7 ± 21.4msecs vs 83.2 ± 14.3msecs, p < 0.05, respectively), whereas E/A ratio was decreased compared with group 2(1.08 ± 0.35 vs 1.43 ± 0.44, p < 0.05). Time-velocity integral of atrial reversal pulmonary venous flow was significantly increased in group 1(1.5 ± 0.5 vs 1.3 ± 0.4, p < 0.05).
3) In group 1, 47.9% had concentric hypertrophy, 41.7% had eccentric hypertrophy and 10.4% had normal left ventricular mass index and left ventricular dimension.
4) In concentric hypertrophy, thickess of ventricular septum and posterior wall were significantly increased, whereas left ventricular end-diastolic dimension was significantly decreased compared with those of patients with eccentric hypertrophy.
5) There were no significant differences of peak E velocity, deceleration time of E wave, E/A ratio, time-velocity integral of E and A wave, isovolumic relaxation time between patients with concentric hypertrophy and eccentric hypertrophy.
6) There were no significant differences of pulmonary venous flow pattern between concentric hypertrophy and eccentric hypertrophy.
7) Systolic blood pressure was identified as an independent factor which associated with left ventricular mass index.

Conclusion

There were no significant differences in diastolic functional indices assessed by Doppler profiles of transmitral inflow and pulmonary venous flow between the patients with concentric hypertrophy and eccentric hypertrophy. The supine systolic blood pressure was identified as an independent factor associated with left ventricular mass index.

Keywords: Hypertension, Patterns of hypertrophy, Diastolic function.

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Fig. 1.
Geometric profiles in hypertensive patients divided by left ventricular mass index and relative wall thickness.
jkse-3-168f1.tif
Fig. 2.
Correlation between left ventricular mass index and systolic blood pressure.
jkse-3-168f2.tif
Fig. 3.
Doppler transmitral flow velocity recording showing Doppler measurements used in this study. E: left ventricular early diastolic peak velocity, A: atrial peak velocity, DT: deceleration time of E wave.
jkse-3-168f3.tif
Fig. 4.
Representative tracings of pulmonary venous flow patterns. A) biphasic forward systolic flow, B) systolic predominant pattern, C) diastolic predominant pattern.
jkse-3-168f4.tif
Table 1.
Clinical and M-mode echocardiographic data of 48 hypertensive patients and 33 normal controls
  Group 1(N=48) Group 2(N=33) p value
Age 53.8 ± 8.9 46.5 ± 12.0 0.098
Sex(Male/Female) 10/38 8/25 0.72
BSA(m2) 1.62 ± 0.29 1.62 ± 0.17 0.991
Systolic BP(mmHg) 160.4 ± 20.4 116.8 ± 7.2 0.000
Diastolic BP(mmHg) 100.5 ± 10.7 76.5 ± 6.3 0.000
Heart rate(beat/min) 64.9 ± 9.6 69.6 ± 10.3 0.074
Septal thickness(mm) 11.2 ± 2.5 8.0 ± 1.6 0.000
Posterior wall thickness 10.8 ± 2.3 8.3 ± 1.5 0.000
Relative wall thickness 2.2 ± 0.4 1.7 ± 0.3 0.000
LVEDD(mm) 49.8 ± 4.0 48.4 ± 3.3 0.097
LA dimension(mm) 35.4 ± 5.4 33.3 ± 6.6 0.179
FS(%) 38.3 ± 7.5 36.1 ± 5.2 0.122
LVEF(%) 71.0 ± 8.9 67.9 ± 6.2 0.075
LV mass(g) 264.1 ± 90.0 166.2 ± 40.5 0.000
LV mass index(g/m2) 158.6 ± 51.2 102.5 ± 24.0 0.000

BSA: body surface area, BP: blood pressure, LVEDD: left ventricular end diastolic dimension, LA: left atrium, FS: fractional shortening, LVEF: left ventricular ejection fraction

Table 2.
Doppler echocardiographic data of 48 hypertensive patients and 33 normal controls
  Group 1(N=48) Group 2(N=33) p value
E(m/sec) 0.74 ± 0.18 0.72 ± 0.17 0.553
A(m/sec) 0.73 ± 0.20 0.53 ± 0.14 0.000
E/A ratio 1.08 ± 0.35 1.43 ± 0.44 0.000
TVIE(cm) 11.9 ± 2.9 11.6 ± 2.9 0.651
TVIA(cm) 10.1 ± 13.2 6.4 ± 2.1 0.128
DT(msec) 231.9 ± 47.6 202.0 ± 40.7 0.006
IVRT(msec) 106.7 ± 21.4 83.2 ± 14.3 0.000
S(m/sec) 0.59 ± 0.13 0.53 ± 0.16 0.053
D(m/sec) 0.40 ± 0.11 0.43 ± 0.13 0.315
Ar(m/sec) 0.23 ± 0.04 0.23 ± 0.07 0.692
TVIS(cm) 15.5 ± 4.3 13.8 ± 3.9 0.068
TVID(cm) 9.0 ± 3.1 8.8 ± 2.9 0.704
TVIAr(cm) 1.5 ± 0.5 1.3 ± 0.4 0.006

E: diastolic early peak velocity, A: diastolic atrial peak velocity, TVIE: time velocity integral of E wave, TVIA: time velocity integral of A wave, DT: deceleration time of E wave, IVRT: isovolumic relaxation time, S: peak systolic forward velocity of pulmonary venous flow, D: peak diastolic forward flow velocity of pulmonary venous flow, Ar: peak velocity of atrial reversal pulmonary venous flow, TVIS, TVID, and TVIAr: time velocity integral of S, D, and Ar wave.

Table 3.
Clinical and M-mode echocardiographic data of concentric and eccentric hypertrophy in 48 hypertensive patients
  Concentric hypertrophy(N=23) Eccentric hypertrophy(N=20) p value
Age 53.2 ± 7.2 54.4 ± 11.3 0.667
Sex(Male/Female) 6/17 4/16 0.861
BSA(m2) 1.69 ± 0.17 1.55 ± 0.39 0.11
Systolic BP(mmHg) 163.7 ± 20.0 159.6 ± 23.5 0.526
Diastolic BP(mmHg) 99.8 ± 8.9 103.6 ± 12.5 0.000
Heart rate(beat/min) 66.2 ± 10.3 63.9 ± 10.1 0.074
Septal thickness(mm) 12.5 ± 2.3 10.7 ± 1.8 0.007
Posterior wall thickness(mm) 12.2 ± 2.4 9.8 ± 1.2 0.000
Relative wall thickness 2.5 ± 0.4 1.9 ± 0.2 0.000
LVEDD(mm) 49.1 ± 4.2 51.5 ± 3.3 0.044
LA dimension(mm) 36.5 ± 5.0 34.5 ± 6.2 0.239
FS(%) 36.8 ± 7.1 40.9 ± 7.3 0.076
LVEF(%) 69.3 ± 9.1 74.1 ± 8.1 0.081
LV mass(g) 302.3 ± 100.4 248.3 ± 54.8 0.032
LV mass index(g/m2) 179.3 ± 58.2 150.4 ± 27.6 0.043

BSA: body surface area, BP: blood pressure, LVEDD: left ventricular end diastolic dimension, LA: left atrium, FS: fractional shortening, LVEF: left ventricular ejection fraction

Table 4.
Doppler echocardiographic data of concentric and eccentric hypertrophy in 48 hypertensive patients
  Concentric hypertrophy(N=23) Eccentric hypertrophy(N=20) p value
E(m/sec) 0.74 ± 0.17 0.75 ± 0.20 0.917
A(m/sec) 0.74 ± 0.22 0.72 ± 0.19 0.698
E/A ratio 1.05 ± 0.32 1.11 ± 0.40 0.622
TVIE(cm) 11.7 ± 3.1 12.0 ± 3.0 0.787
TVIA(cm) 12.8 ± 19.1 7.9 ± 2.0 0.264
DT(msec) 241.8 ± 46.3 223.5 ± 50.0 0.225
IVRT(msec) 108.3 ± 17.2 109.4 ± 21.1 0.850
S(m/sec) 0.59 ± 0.14 0.58 ± 0.11 0.796
D(m/sec) 0.39 ± 0.10 0.43 ± 0.13 0.308
Ar(m/sec) 0.23 ± 0.04 0.24 ± 0.06 0.839
TVIS(cm) 14.9 ± 4.4 15.6 ± 4.4 0.614
TVID(cm) 8.4 ± 3.2 10.0 ± 3.2 0.105
TVIAr(cm) 1.6 ± 0.5 1.4 ± 0.3 0.231

E: diastolic early peak velocity, A: diastolic atrial peak velocity, TVIE: time velocity integral of E wave, TVIA: time velocity integral of A wave, DT: deceleration time of E wave, IVRT: isovolumic relaxation time, S: peak systolic forward velocity of pulmonary venous flow, D: peak diastolic forward flow velocity of pulmonary venous flow, Ar: peak velocity of atrial reversal pulmonary venous flow, TVIS, TVID, and TVIAr: time velocity integral of S, D, and Ar wave.

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