Systemic hypertension
Abnormal left ventricular filling: An early finding in mild to moderate systemic hypertension

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Abstract

This study was undertaken to determine the prevalence and significance of diastolic left ventricular (LV) dysfunction in mild to moderate systemic hypertension. Rest and exercise equilibrium blood pool scintigraphy was performed in 39 hypertensive subjects (mean systolic blood pressure [BP] 156 ± 14 mm Hg [± standard deviation];mean diastolic BP 103 ± 5 mm Hg) and 11 normal control subjects. These studies were analyzed for ejection fraction (EF), segmental wall motion, peak filling rate (PFR), time to PFR and filling fraction in the first third of diastole normalized for cycle length (first-third filling fraction).

EF at rest was similar in the hypertensive patients and control subjects (0.63 ± 0.09 versus 0.65 ± 0.07);only 2 patients had a reduced EF. The EF response to exercise was normal in every hypertensive patient (increasing to a mean of 0.74 ± 0.08);only 1 patient had asynergy. In contrast, even when the 2 patients with abnormal systolic function were excluded, each index of diastolic filling was significantly different from the control group. PFR was lower (2.29 ± 0.49 vs 2.63 ± 0.39 end-diastolic volumes per second [EDV/s], p < 0.05), time to PFR was longer (199 ± 47 versus 158 ± 17 ms/s), p < 0.01) and first-third filling fraction was smaller (0.38 ± 0.11 vs 0.60 ± 0.07, p < 0.001). The latter index fell below the lowest normal value in 84% of the hypertensive patients. The degree of diastolic filling abnormality was not related to the patients' age, heart rate, BP, duration of systemic hypertension or systolic function. However, patients with echocardiographic evidence of LV hypertrophy had more abnormal diastolic filling measurements, and significant correlations were present between posterior wall thickness and first-third filling fraction (r = −0.66, p < 0.001) and between mass and time to PFR (r = 0.80, p < 0.001).

These findings indicate that diastolic abnormalities may be an early finding in hypertensive heart disease and that they are, at least in part, related to the degree of LV hypertrophy.

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    This work was supported in part by Grant HL 28146 from the National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland.

    Dr. Massie is a Clinical Investigator of the Veterans Administration Research Service.

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