The Evaluation of the Left Ventricular Diastolic Function in the Patients with Essential Hypertension by Phonocardiogram and Doppler Echocardiogram

ABSTRACT

There is no doubt that the diastolic dysfunction of the left ventricular plays an important role in the pathophysiogy of clinical heart faliure in some patients, if not all, and that many hypertensive subjects manifest diastolic dysfunction of the left ventricle in its early hypertensive stage. But yet, it is not clear which paramenter is most sensitive and/or specific, and consistent with pathophysiologic states. In order to have an insight into the problems, 30 hypertensives and 30 normotensive subjects were studied by phonocardiogram and pulsed Doppler echocardiogram at the left ventricular inflow and then isovolumic relaxation time(A2D time), early diastolic deceleration time(EDDT), early diastolic deceleration rate(EDDR), late diastolic time(LDT), E.A velocity ratio[E/A(v)]and E/A area ratioA(a)] were measured and calculated. And the values of each parameters of different groups were subgrouped according to the severity of the hypertension(Group Amild, Bmoderate and Csevere hypertension) and according to the LV mass(Group DLVMI or =125g/m2) were compared with those of the normal control subjects and also between each subgroups. The results were as follows 1) In the 30 normotensive subjects, A2D time was averaged out 60.8+/-12.5msec, E/A(v) 1.55+/-0.59, E/A(a) 2.61+/-1.35, EDDT 1.35+/-37.8msec, EDDR8.3+/-4, 6m/sec2 and LDT 151+/-42.2msec. 2) In group A, A2D time was significantly prolonoged(82.5+/-26.0msec, pD and EDDT were significantly prolonged(p<0.005), while E/A(v), E/A(a) and EDDR wer significantly decreased(p<0.005, p<0.05 respectively). 6) In group E, A2D and EDDT were significantly increased(p<0.005, p<0.05 respectively), while E/A(v) and EDDR significantly decreased(p<0.005, p<0.05 respectively). Above results suggest that diastolic function of the left ventricle can be deteriorated in the hypertensive subjects before systolic dysfunction is apparent even in the mild hypertensives and in the patients devoid of hypertensive hypertrophy of the left ventricle.