Left ventricular hypertrophy and its regression in essential arterial hypertension. A tissue Doppler imaging study.
The mitral annulus velocities of Doppler transmitral flow and pulsed-wave tissue Doppler imaging (TDI) were sampled by echocardiography for the assessment of left ventricular (LV) diastolic function in 118 never-treated essential hypertensive patients with normal systolic function and compared with those of 59 normotensive healthy subjects matched for age and sex. A selected group (n = 26) of the hypertensive study population was observed after 1 year of pharmacologic antihypertensive treatment to determine the behavior of TDI parameters in relation to eventual regression of LV hypertrophy (LVH). We found that the TDI early myocardial diastolic wave (E(m)) was significantly lower both in concentric and eccentric LVH. In addition, TDI late myocardial diastolic wave (A(m)) was significantly higher in concentric remodeling and concentric and eccentric hypertrophy. The TDI E(m)/A(m) ratio was significantly lower in all geometric remodeling subgroups. The E/A ratio Doppler transmitral flow velocity measured showed that of the 118 patients, only 32 (25%) could really be discriminated from normal, whereas individual analysis for TDI E(m)/A(m) at the mitral annulus septal level showed that of 118 patients 108 (91%) could be discriminated from normal P < .001). The LV mass was significantly less after 1 year of treatment (LVH regression), and TDI parameters showed a trend toward normalization, in particular of TDI E(m)/A(m) at the annular septal level. Pulsed-wave TDI analysis could enable not only the early assessment of whether a patient is still in an adaptive or compensatory phase before transition to irreversible damage (pathologic phase) but also the detection of precocious LV global diastolic dysfunction. With regard to this, more extensive randomized studies are needed to evaluate the effect of different pharmacologic treatments (calcium antagonists, beta-blockers, angiotensin I and II inhibitors) on TDI parameters.
Cardiac and Thoracic Department, University of Pisa, Pisa, Italy. vdibello@med.unipi.it
Vitantonio
V
Di Bello
Davide
D
Giorgi
Roberto
R
Pedrinelli
Enrica
E
Talini
Caterina
C
Palagi
Maria Grazia
MG
Delle Donne
Giulio
G
Zucchelli
Giulia
G
Dell'omo
Andrea
A
Di Cori
Rita
R
Dell'Anna
Paolo
P
Caravelli
Mario
M
Mariani
D000328:Adult; D000959:Antihypertensive Agents / Q000627:therapeutic use; D016022:Case-Control Studies; D015150:Echocardiography, Doppler; D018619:Echocardiography, Doppler, Pulsed; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging* / Q000209:etiology*; D008875:Middle Aged; D012680:Sensitivity and Specificity; D020257:Ventricular Remodeling
D000959:Antihypertensive Agents