ABSTRACT
Systolic and diastolic function is impaired in patients with hypertensive heart disease. Systolic hypertension induces a succession of LV hemodynamic changes and can be regarded as a spectrum from maladaptive hypertophy to heart failure. The left ventricular hemdynamic changes that occur can be measured non-invasively by Doppler echocardiography. The aim of the study was to hemodynamically characterize the different phases of left ventricular [LV] function in patients affected by systemic hypertension [SH]. 95 normotensive healthy controls [group I] and 94 hypertensives [group II] were enrolled. Hypertensive patients were divided in two sub-groups according to echocardiographic signs of left ventricular hypertrophy [LVH]. Other echocardiographic parameters measured using tissue Doppler were Isovolumic Relaxation Time [IRT], isovolumic contraction time [ICT], and systolic motion [Sm]. Myocardial Performance Index [MPI] using Tissue Doppler Echocardiography [TDE] was defined in both the control group and the two hypertensive subgroups. Ejection fraction [EF] was also calculated in all participants. An increased MPI derived from the rise of isovolumetric relaxation time [IRT] was found in hypertensives without LVH [sub-group II-a], whereas isovolumetric contraction time [ICT] and Systolic motion [Sm] were unchanged. Hypertensive patients with LVH demonstrated more prominent increase of MPI, increase in IRT-prolongation, ICT-increase and Sm-decrease. The results obtained indicate impaired relaxation in sub-group II-a. On the contrary, a systolo-diastolic LV dysfunction was found in sub-group II-b. E.F decreased in this same sub-group of hypertensives in comparison with controls and sub-group II-a, as a sign of maladaptive LVH evolving towards heart failure. Doppler echocardiography appears able to distinguish the different forms and degrees of LV dysfunction in SH in relation to the different phases of the hypertensive disease process
ABSTRACT
In this study, ejection fraction% [EF%] and myocardial performance index [MPI] were recorded in 67 survivors at early, intermediate and late phase of acute myocardial infarction [AMI] .EF% was echocardiographically obtained by the Simpson's method; MPI was calculated using Tissue Doppler Echocardiography [IDE] derived from isovolumetric contraction time [ICT]; isovolumetric relaxation time [IRT] and ejection time [ET]. Results were compared with those obtained in 70 controls matched for age and sex.At hospital discharge [early evaluation], EF% was < 50% with significant increase in MPI in respect to the healthy controls [increase in ICT, significant reduction in ET and IRT was unchanged]. Six months later [intermediate evaluation], EF% still resulted in < 50%, MPI was slightly reduced with further increase in ICT and IRT in comparison to the early evaluation, and slight reduction in ET Finally, one year later [late evaluation], in spite of increase in EF>50%, MPI was still increased, with slight rise in ICT, almost normalization in ET, but more evident increase in IRT. The outcomes of MPI demonstrate that in post-AMI patients, late prevalent diastolic ventricular dysfunction occurs following an early systolic dysfunction. In this study, EF% appears to be less sensitive than MPI in defining late post-AMI left ventricular dysfunction. Finally,TDE seems to be more sensitive than conventional Doppler method in measuring MPI