title: Impaired left ventricular diastolic function during isometric exercise in asymptomatic patients with hyperlipidaemia.
abstract: BACKGROUND
  Left ventricular (LV) diastolic dysfunction is an early sign, and may be more sensitive indicator, of ischaemic heart disease (IHD) than systolic dysfunction.
  
  
  METHODS
  LV diastolic function was assessed during isometric exercise (IME) in 37 consecutive normotensive hyperlipidaemics (LIP), without cardiac history or symptoms. Each patient underwent a stress ECG test and 2-D echo and Doppler cardiography. During the latter, transmitral flow at rest and at peak standardised IME using handgrip was studied. From the tracings, the E/A (peak velocity of the early/atrial components), the contribution of atrial systole to LV filling (ACF), the deceleration time (DT) of the E wave and the isovolumic relaxation time (IVRT) were calculated. Results were compared to 37 age-matched normal healthy volunteers (NOR).
  
  
  RESULTS
  Resting E/A was not different between NOR and the LIP. A significant reduction in E/A with IME was observed in LIP but not in NOR. Impaired LV filling (shown by E/A<1) was demonstrated in five patients (13%) at rest and in 20 patients (54%) at peak IME. All NOR had E/A>1 suggesting normal LV filling. Fifteen of the 30 patients with negative stress ECG test demonstrated LV diastolic dysfunction. ACF was higher in LIP than NOR and increased significantly (P<0.005) by 23% during IME. DT and IVRT in LIP were not different from NOR. In neither NOR nor LIP, were the LV diastolic functional parameters related to gender, smoking habit or levels of total cholesterol, LDL- or HDL-cholesterol or triglycerides.
  
  
  CONCLUSIONS
  The prevalence of LV diastolic dysfunction in asymptomatic patients with hyperlipidaemia despite a negative stress ECG test may be evidence of early underlying pre-clinical myocardial ischaemia.
authors.affiliation: Cardiac Research Unit, Cardiology Department, The Central Middlesex Hospital, Acton Lane, London NW10 7NS, UK. majeed.salmasi@nwlh.nhs.uk
authors.forename: Abdul-Majeed
authors.initials: AM
authors.lastname: Salmasi
authors.forename: Peter
authors.initials: P
authors.lastname: Frost
authors.forename: Mark
authors.initials: M
authors.lastname: Dancy
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D003971:Diastole; D015444:Exercise; D005080:Exercise Test; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000150:complications*; D007537:Isometric Contraction; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012044:Regression Analysis; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000209:etiology*