Diastolic Function Evaluation in Systemic Arterial Hypertension: A Color M-mode Doppler and Doppler Echocardiographic Analysis

Seung-Ho Hur; Kee-Sik Kim; Kyu-Chan Hur; Seong-Wook Han; Dae-Woo Hyun; Kyeung-Mok Shin; Yoon-Nyun Kim; Kwon-Bae Kim

doi:10.3803/jkes.1996.4.1.47

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Hur, Kim, Hur, Han, Hyun, Shin, Kim, and Kim: Diastolic Function Evaluation in Systemic Arterial Hypertension: A Color M-mode Doppler and Doppler Echocardiographic Analysis

Original Article

J Korean Soc Echocardiogr 1996;4(1):47-56.

Published online: 18 February 1996

DOI: https://doi.org/10.3803/jkes.1996.4.1.47

Diastolic Function Evaluation in Systemic Arterial Hypertension: A Color M-mode Doppler and Doppler Echocardiographic Analysis

Seung-Ho Hur, M.D., Kee-Sik Kim, M.D., Kyu-Chan Hur, M.D., Seong-Wook Han, M.D., Dae-Woo Hyun, M.D., Kyeung-Mok Shin, M.D., Yoon-Nyun Kim, M.D., Kwon-Bae Kim, M.D.

Division of Cardiology, Department of Internal Medicine, School of Medicine, Keimyung University, Taegu, Korea

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

Several recent studies have demonstrated that left ventricular diastolic dysfunction is major cause of congestive heart failure and may precede systolic dysfunction or without left ventricular hypertrophy in most patients with systemic arterial hypertension.

The purpose of this study is to evaluate left ventricular diastolic function in patients with systemic arterial hypertension compared with normal control group using color M-mode Doppler and Doppler echocardiographic studies.

Methods

From October 1994 to August 1995. 53 patients(18 men and 35 women, mean age: 56.1 ± 12.6years) with essential hypertension and 30 subjects age-matched normal controls(13 men and 17 women, mean age 55.9 ± 12.3years) were included in this study. We measured the early propagation slope of LV inflow by color M-mode Doppler echocardiography and the peak velocities of E and A wave, E/A ratio, deceleration time of E wave, isovolumic relaxation time by Doppler echocardiography.

We also studied left ventricular diastolic function in patients with hypertension who were divided two group(Group I: hypertension with left ventricular hypertrophy, Group II: hypertension without left ventricular hypertrophy)

Results

1) Early propagation slope of LV inflow was significantly decreased in patients with hypertension compared with normal control group(57.43 ± 17.15msecs vs 69.87 ± 12.71msecs, p<0.05).

2) Peak velocity of A wave and isovolumic relaxation time were significantly increased in patients with hypertension compared with normal control group(0.79 ± 0.2m/sec vs 0.69 ± 0.17m/scc, 132.96 ± 36.98msecs vs 108.67 ± 23.30msecs, p<0.05), whereas E/A ratio was significantly decreased in patients with hypertension compared with normal control group(0.96 ± 0.42 vs 1.18 ± 0.43, p<0.05). Peak velocity of E wave and deceleration time of E wave were not significantly different between in patients with hypertension and normal control group, but peak velocity of E wave was showed decreasing tendency in patients with hypertension compared with normal control group(0.75 ± 0.38m/sec vs 0.77 ± 0.17m/sec, p>0.05), whereas deceleration time of E wave was showed increasing tendency in patients with hypertension compared with normal control group(196.57 ± 37.07msecs vs 189.33 ± 41.35msecs, p>0.05).

3) Early propagation slope of LV inflow was not significantly different between Group I and Group II, but showing decreasing tendency in Group I compared with Group 11(54.72 ± 14.65m/sec vs 60.16 ± 18.96m/scc, p>0.05). Peak velocity of E wave and peak velocity of A wave and E/A ratio and deceleration time were not significantly different between Gropu I and Group II but peak velocity of E wave and E/A ratio were showed decreasing tendency in Group 1(0.65 ± 0.19m/sec vs 0.73 ± 0.22m/sec, 0.86 ± 0.40 vs 1.04 ± 0.44, p>0.05), whereas peak velocity of A wave and deceleration time of E wave were showed increasing tendency in Group 1(0.80 ± 0.20m/sec vs 0.74 ± 0.18m/sec, 199.38 ± 46.45msecs vs 196.89 ± 24.76msecs, p>0.05). Only isovolumic relaxation time was significantly increased in Group I compared with Group II(150.63 ± 44.75msecs vs 120.34 ± 19.77msecs, p<0.05).

Conclusion

Left ventricular diastolic dysfunction may precrede systolic or without left ventricular hypertrophy in patients with systemic arterial hypertension.

An early diagnosis of left ventricular diastolic dysfunction, color M-mode Doppler echocardiography and Doppler echocardiography were useful diagnostic stools.

Keywords: Diastolic dysfunction, Color M-mode doppler echocardiography, Hypertension.

References

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Fig. 1.

Shematic illustration of the levels used for analysis of left ventricular filling. The heart was shown in the apical 4-chamber view.

Fig. 2.

Early flow propagation slope of LV inflow(arrows) was shown as a linear segment of early filling flow from mitral opeing to LV apical region and was defined as a border of red to yellow color change using color M-mode Doppler echocardiography.

Fig. 3.

Comparison of early flow propagation slope of E wave using color M-mode Doppler echocardiography between the patients with hypertension and normal control group.

Fig. 4.

Comparison of peak velocities(Vmax) of E & A waves(A) and E/A ratio(B) using Doppler echocardiography between the patients with hypertension and normal control group.

Fig. 5.

Comparison of deceleration time(DT) of E wave and isovolumic relaxation time(IVRT) using Doppler echocardiography between the patients with hypertension and normal control group.

Fig. 6.

Comparisom of LV diastolic dimension(LVDd), LV systolic dimension(LVDs), interventricular septum (IVS), LV posterior wall(LVPW) and LA dimension (LAD) using two-dimensional echocardiography between the patients with hypertension and normal control group.

Fig. 7.

Comparison of LV ejection fraction(LVEF), LV mass index(LVMI) using two-dimensional echocardiography between the patients with hypertension and normal control group.

Table 1.

Comparison of left ventricular diastolic function using color M-mode Doppler and Doppler echocardiography between the patients with hypertension(HTN) and normal control group

	Control	HTN	p value
No. of patients	30	53
Age(yr)	54.97 ± 12.27	56.12 ± 12.62	NS
E-Propa.(m/sec)	69.87 ± 12.71	57.43 ± 17.15	<0.01
E-Vmax.(m/sec)	0.77 ± 0.17	0.75 ± 0.38	NS
A-Vmax(m/sec)	0.69 ± 0.17	0.79 ± 0.20	<0.05
E/A ratio	1.18 ± 0.43	0.96 ± 0.42	<0.05
DT(mesec)	198.33 ± 41.35	196.57 ± 37.07	NS
IVRT(msec)	108.67 ± 23.30	132.96 ± 36.98	<0.01
LVDd(cm)	4.89 ± 0.44	4.93 ± 0.63	NS
LVDs(cm)	2.89 ± 0.38	3.07 ± 0.63	NS
IVS(cm)	0.86 ± 0.16	1.18 ± 0.29	<0.01
LVPW(cm)	0.78 ± 0.15	1.05 ± 0.29	<0.01
LVMI(g/m²)	84.42 ± 16.24	128.8 ± 50.33	<0.01
LVEF(%)	78.86 ± 5.64	74.51 ± 10.82	<0.05
LAD(cm)	3.38 ± 0.41	3.57 ± 0.46	NS

E-Propa.: early propagation slope of LV inflow, E-Vmax: peak velocity of E wave, A-Vmax: paek velocity of A wave, DT: deceleration time of E wave, IVRT: isovolumic relaxation time

Table 2.

Comparison of left ventricular diastolic function using color M-mode Doppler and Doppler echocardiography between the patients with hypertension combined left ventricular hypertrophy(group I) and not combined left ventricular hypertrophy(group II)

	I	II	p value
No. of patients	25	28
Age(yr)	58.63 ± 12.82	53.93 ± 12.46	NS
E-Propa.(m/sec)	54.72 ± 14.65	60.16 ± 18.96	NS
E-Vmax.(m/sec)	0.65 ± 0.19	0.73 ± 0.22	NS
A-Vmax(m/sec)	0.80 ± 0.20	0.74 ± 0.18	NS
E/A ratio	0.86 ± 0.40	1.04 ± 0.44	NS
DT(mesec)	199.38 ± 46.45	196.89 ± 24.76	NS
IVRT(msec)	150.63 ± 44.75	120.34 ± 19.77	p<0.05
LVDd(cm)	4.91 ± 0.77	4.99 ± 0.45	NS
LVDs(cm)	2.98 ± 0.82	3.13 ± 0.43	NS
IVS(cm)	1.42 ± 0.24	1.00 ± 0.11	p<0.01
LVPW(cm)	1.30 ± 0.22	0.85 ± 0.13	p<0.01
LVMI(g/m²)	165.51 ± 50.25	100.80 ± 19.17	p<0.01
LVEF(%)	74.24 ± 10.82	74.61 ± 6.98	NS
LAD(cm)	3.77 ± 0.43	3.42 ± 0.42	NS

E-Propa.: early propagation slope of LV inflow, E-Vmax: peak velocity of E wave, A-Vmax: paek velocity of A wave, DT: deceleration time of E wave, IVRT: isovolumic relaxation time

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