Left ventricular mass and filling pattern in patients with hypertension: doppler echocardiographic criteria for selection of antihypertensive agents

The objective of this study was to determine the value of Doppler echocardiographic derived left ventricular [LV] mass and filling patterns to guide selection of antihypertensive agent that favorably modulates the cardiac effects of hypertension. Thirty-six patients with mild to moderate hypertension were divided into three groups [12 patients each]. Patients who had reduced LV early filling pattern [early to late mitral flow velocity ratio <1] received nifedipine [group 1]. Patients who had increased LV mass index had received captopril [group 2]. Patients received atenolol were selected randomly [group 3]. All the three drugs showed significant decrease of systolic and diastolic blood pressure within six weeks of treatment. LV systolic function was preserved in all groups. Nifedipine was most effective to improve LV diastolic function by increasing early LV filling and shortening the isovolumic relaxation time. Captopril was most effective reducing LV mass, however, it was not associated with improving LV diastolic function. In conclusion, echocardiographic derived LV mass index and LV filling pattern successfully guided the use of captopril and nifedipine in hypertensive patients. LV mass regression and LV diastolic function improvement with antihypertensive therapy remains a surrogate endpoint. However, their influence on morbidity and mortality in patients with hypertension remains a required information

Diastolic function abnormalities in young symptomatic diabetic patients assessed by pulsed doppler echocardiography

The objective of this study was to evaluate left ventricular [LV] diastolic function in young asymptomatic insulin-dependent diabetic patients. Thirty young asymptomatic patients [<35 years] and 15 control subjects were included. Patients were not received medications except insulin. Autonomic function tests, fundus examination were used to evaluate diabetic complications. Blood glucose and lipid profile were measured in all patients. M-mode, two-dimensional and Doppler echocardiography were used to study LV systolic and diastolic functions. Peripheral neuropathy was present in all patients and autonomic neuropathy in 23 [73.3%], resting tachycardia in 12 patients [40%], proteinuria in 14 [46.7%], retinopathy in 7 patients [23.3%]. Eight patients [26.7%] had LV diastolic dysfunction represented by decreased E filling and increased A with reversed PE/PA and increase atrial contribution of diastolic filling as compared to other diabetics. There was significant correlation between diastolic dysfunction, diabetic complications [r=0.51, P <0.05] and blood glucose [r=0.49, P <0.05], but not correlated with duration of diabetes or insulin dose. It was concluded that subclinical LV diastolic dysfunction is present in diabetic and is related to microvascular complications and hyperglycemia, but not related to the duration of the disease or insulin dose

Echocardiographic study of left ventricular diastolic function in patients with chronic right ventricular enlargements

To determine whether abnormalities in left ventricular geometry due to right ventricular enlargement result in abnormalities in left ventricular diastolic filling pattern, the pulsed Doppler transmitral recording was obtained from 13 patients with right ventricular dilatation and right ventricular systolic pressure estimated to be <40 mmHg [group I], 22 patients with right ventricular dilatation and right ventricular systolic pressure >/40 mmHg [group II] and 8 normal subjects served as control group. Results were discussed in detail