[Reduced distensibility of the hypertensive heart under stress as an early sign of diastolic dysfunction].
BACKGROUND
Hypertensive patients often present with exertional dyspnoea. However it is questioned whether it results from a systolic, early- or late diastolic impairment of left ventricular function.


METHODS
Our study included 21 hypertensive patients (7 female; 14 male, median age 56 years) and 12 controls (4 female; 8 male, median age 52 years). All patients had normal epicardial coronary arteries. Parameters of systolic and diastolic heart function at rest and during exercise were analyzed using a combined hemodynamic and radionuclid-angiographic approach.


RESULTS
One principal finding was that the investigated hypertensive patients had a normal ejection fraction during exercise (72 % +/- 11 vs 71 % +/- 10 in the control group). However these patients showed an exercise induced increase of pulmonary capillary wedge pressure (17.4 +/- 8 vs 11.5 +/- 5; p = 0.005), a fixed end diastolic volume (82 +/- 21 vs 104 +/- 23 ml/m (2), p = 0.01) and a reduced stroke volume index (58 +/- 1.2 vs 73 +/- 1.4 ml/m (2); p = 0.007). Radionuclid angiography revealed an increased exercise peak filling rate (6.1+/-1.6 vs 4.8+/-1.8 EDV/s; p = 0.04) in hypertensive patients. We assume that exercise capacity (cardiac index = 8.1 +/- 1.8 vs 8.4 +/- 2.2 l/min x m (2); ns) in hypertensive patients without excessive LV hypertrophy is predominantly preserved by an enhanced contractile state and its favorable effects on early diastolic filling.


CONCLUSIONS
An increased left ventricular stiffness during exercise is an early manifestation of hypertensive heart disease.
Plehn
G
G
Klinik für Kardiologie, Angiologie und Pneumologie, Medizinische Klinik und Poliklinik B, Heinrich-Heine-Universität Düsseldorf. gplehn@gmx.de
Schwartzkopff
B
B
D000959:Antihypertensive Agents / Q000627:therapeutic use; D001794:Blood Pressure; D016022:Case-Control Studies; D003971:Diastole; D004452:Echocardiography; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011669:Pulmonary Wedge Pressure; D011875:Radionuclide Angiography; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology
D000959:Antihypertensive Agents