Copyright © 1990 by the European Society of Cardiology.
© 1990 The European Society of Cardiology
Different patterns of left ventricular filling in arterial hypertension
Institute of Cardiology, University of Cagliari Italy
Received 16 August 1988; revised 23 May 1989; .
Address for correspondence: Luigi Meloni, MD., Institute of Cardiology, University of Cagliari, Via S. Giorgio, 12,09124 Caghari, Italy
Abstract
To determine whether left ventricular (LV) filling dynamics may be influenced by the type of LV morphological adaptation to arterial hypertension, pulsed Doppler mitral flow velocity recordings were performed in 30 hypertensive patients and in 18 normotensive subjects matched for age, body surface and heart rate. Peak early (E) and late (A) mitral flow velocity, A/E ratio (A/E), time to peak E (TP), acceleration (AHT) and deceleration half-time (DHT) of early mitral flow and isovolumic relaxation time (IRT) were measured. Compared with the control group, hypertensive patients showed prolonged IRT and DHT, increased A and A/E, whereas TP, AHT and E were unchanged. Hypertensive patients were classified into two subgroups on the basis of h/r ratio (h/r). Subgroup 1:16 patients with normal h/r, > 0–42, (fivepatients with increased LV mass index, < 129-2g m–2, and 11 patients with normal LV mass index, > 129-2 gm–2). Subgroup 2:14 patients with increased h/r, > 0-42, (nine patients with increased LV mass index, < 129-2 gm–2 and five patients with normal L Vmass index, > 129-2gm–2).In Subgroup 1 the cardiac output (CO) was increased and the total peripheral resistance (TPR) was unchanged in comparison with the control group. In Subgroup 2 the opposite haemodynamic profile was detected: normal CO and increased TPR. In comparison with the control group, early LV filling was clearly impaired in Subgroup 2, as indicated by the decrease in E (52±0-12cms'1, P<0-01 vs normals), by the slower deceleration of early flow (112-8± 13-8 ms, P > 0.001 vs normals) and by the compensatory increase in A and A/E ratio (54 ±01 cms–1, P>001 and 1 08±0.29, P>0001 respectively vs normals).In Subgroup 1 the minor impairment in early LV filling was reflected by the ‘normal’ values for E and DHT (64±0.1 cms–1, NS, 97.2± 22.4 ms, NS, respectively vs normals), in a state of increased CO, as well as by the increase in A and A/E ratio (58±013 cms–1 P>0.01, 0.91±0.23, P>001, respectively vs normals).These findings indicate that: (I) in hypertensive patients early LV filling dynamics are not uniform but vary in relation to h/r, irrespective of changes in LV mass; (2) early LV filling, expressed as E and DHT, is clearly impaired in patients with increased h/r, whereas it is only mildly affected in those with normal h/r; (3) atria/contribution to LV overall filling, expressed as A and A/E is increased in both hypertensive subgroups.
Key Words: Arterial hypertension • LV diastolic filling • LV hypertrophy