engleski

Early detection of hypertensive heart disease by measuring regional myocardial diastolic dysfunction assessed by color Doppler myocardial imaging.

Purpose: Doppler echocardiography of the mitral valve and pulmonary veins inflow often reveals global diastolic dysfunction in hypertensive patients. The assessment of regional diastolic function is crucial in understanding the pathophysiological process and diagnosing subclinical myocardial changes. Therefore, we sought to analyze segmental myocardial relaxation using Color Doppler Myocardial Imaging (CDMI) in hypertensive patients without fulfilled criteria for first grade diastolic dysfunction in conventional Doppler. Methods: The study comprised 32 treated hypertensive pts. (48&#177; 7.3 years, normal myocardial thickness and normal systolic function) with well regulated blood pressure according to values from previous 24h BP monitoring and 11 healthy age matched normals. All subjects underwent DMI (E&#8217; , A&#8217; at annulus, base and middle segment (s.) of each wall (w.) in longitudinal views) as well as Doppler echocardiography (IVRT, PFVE, PFVA, DtE, Adur, PVA, PVAdur) at baseline, 3- and 6-month follow up. The non-parametric Mann-Whitney test was used for statistical analysis. P value <0.05 *vs. control group, #vs. baseline. Results: CDMI revealed global and regional impairment of relaxation: at baseline: 1. regional E&#8217; /A&#8217; <1 was found in 2/18 s. or 11% (in basal s. of posterior and septal w.). 2. All segments mean was: E&#8217; /A&#8217; =2.01&#177; 0.77, n.s. 3-mo follow up: 1. regional E&#8217; /A&#8217; <1 was found in 5/18 s. or 28% (in basal s. of posterior, inferior, septal and lateral w. as well as middle s. of posterior w.) 2. All segments mean was: E&#8217; /A&#8217; =1.6&#177; 0.7, p<0.05*. 6-mo follow up: 1. regional E&#8217; /A&#8217; <1 was found in 6/18 or 33% of all s. (in basal s. of posterior, lateral, inferior and septal w. and middle s. of posterior and inferior w). 2. All segments mean: E&#8217; /A&#8217; =0.98&#177; 0.17, p<0.01*, p<0.05#. Conclusion: CDMI parameters in these patients revealed regional diastolic dysfunction at baseline while standard Doppler parameters were normal. Regional diastolic changes were the earliest sign of hypertensive heart disease in our patients, followed by CDMI parameters of global diastolic dysfunction in 6-month follow up. These data might have significant clinical value in diagnosis of subclinical hypertensive heart disease and follow up of the treatment.

hypertension; Doppler myocardial imaging

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