engleski

DO LATE DIASTOLIC PARAMETERS CHANGE IN MILD HYPERTENSIVE HEART DISEASE? - TISSUE DOPPLER STUDY

Background: Impaired relaxation during early diastole is very well known in hypertensive heart disease. By standard Doppler echocardiography (PWE) global diastolic dysfunction is easily measured. It is not clear whether structural changes of myocardium induce other functional disturbances during diastole apart from the relaxation. By measuring myocardial velocities using high temporal resolution Tissue Doppler Imaging (TDI) we are enable to analyze regional myocardial function particularly fine diastolic dysfunction of each segment (s.). In order to evaluate late diastolic function we sought to measure TDI parameters in hypertensive pts. Methods: treated hypertensive pts (48&plusmn ; 7.3 yrs, EF2D 58&plusmn ; 12%) with normal exercise test were randomised in 2 groups according to blood pressure (BP) control. Group A -uncontrolled BP (27 pts) ; group B-well control BP (30 pts). Both groups and 13 healthy age match normals (n.) underwent TDI and PWE at baseline and at 3-month follow-up. Following parameters were measured: 1.TDI: peak early diastolic velocity-E&#8217; , peak late diastolic velocity-A&#8217; , acceleration time A&#8217; -AcctA&#8217; , deceleration time A&#8217; - DtA&#8217; from annulus, base and middle (s.) of each wall and basal posterior s. in short (SAX) and long axis (LAX)) 2. PWE Doppler parameters (p.): E/A, DtE, Adur, Pulmonary vein A (PVA) and PVAdur. For statistical analysis the non-parametric Mann-Whitney test was used.&#61482; p<0.05 vs.n., &#61475; p<0.05 vs.group B, &#61542; p<0.05 vs.baseline. Results: At baseline in group A all PWE and TDI p. revealed relaxation disturbances. TDI study reveled significantly higher A&#8217; (mean v. for all s. =7.37&plusmn ; 1.47cm/s&#61482; ) and longer AcctA (mean all s. = 0.07&plusmn ; 0.01ms&#61482; ) compare to n.. In group B PWE p. were normal but TDI showed relaxation disturbances in 3/21 or 19% of s. along with prolong AcctA (0.06&plusmn ; 0.009ms&#61482; ) in the same regions. At follow-up in group A PWE p. have not been changed while TDI p. revealed: higher A&#8217; velocity (8.88&plusmn ; 1.9cm/s&#61482; &#61475; &#61542; ), longer AcctA (0.08&plusmn ; 0.01ms&#61482; &#61475; &#61542; ), and longer DtA (0.08&plusmn ; 0.012ms &#61482; &#61475; &#61542; ) compare to baseline and between groups in majority of segmets (73%). In group B at follow up no change in PWE parameters were occurred. TDI parameters of impaired relaxation occurred in more segments compare to baseline (5/21 or 23%) along with higher mean value A&#8217; (7.5&plusmn ; 2.3cm/s&#61482; &#61475; &#61542; ) and prolong AcctA (0.09&plusmn ; 0.01ms&#61482; &#61475; &#61542; ), and DtA (0.09&plusmn ; 0.01ms &#61482; &#61475; &#61542; ) in the same s. Conclusion: In hypertensive pts. using TDI we found regional late diastolic dysfunction in myocardial segments with impaired relaxation. After 3 month follow up late diastolic parameters in those segments become worse. Percentage of segments with early and late diastolic dysfunction after 3 month increased despite the treatment. It seems that along with impaired relaxation other functional disturbances occurs during diastole in hypertensive heart disease even in treated pts.

diastolic dysfunction; tissue Doppler echocardiography; hypertension

nije evidentirano