Changes in left ventricular outflow and intraventricular flow patterns in hypertension and controls: a Doppler echocardiographic study.
OBJECTIVE
It has been previously reported that intraventricular flow patterns in some hypertensive patients with left ventricular hypertrophy, change to patterns similar to flow profiles of hypertrophic cardiomyopathy. The purpose of the study was to assess left ventricular outflow and mid-septal intraventricular flow patterns in hypertensive and normotensive patients.


METHODS
Left ventricular outflow and mid-septal flows of 68 patients (41 men, mean age 53 +/- 14 years) and 45 non-hypertensive healthy controls (26 men, mean age 43 +/- 16 years) were assessed with Doppler echocardiography. Acceleration slope, pre-ejection period (PEP), and velocity-time integrals of the flows were recorded at the level and 1, 2 and 4 cm below the aortic valve. M-mode parameters of left ventricular wall thicknesses, dimensions and ejection fractions were also recorded. The data was analysed with the paired Student's t test with pre-hoc Bonferoni correction of the level of significance (0.05/4 = 0.0125) for multiple comparisons.


RESULTS
In normotensive patients the acceleration slope uniformly and statistically significantly decreased beneath the aortic annulus and PEP was unchanged. In hypertensive patients the acceleration slope steepened (1596 +/- 531 vs. 1948 +/- 700 cm/sec, p < 0.05) and PEP decreased (108 +/- 23 vs. 98 +/- 20 msec, p < 0.05) 1 cm below the aortic valve and later reverted to the normal pattern of decrease seen in normotensive patients.


CONCLUSIONS
The increase in acceleration slope and decrease in PEP in the subvalvular region may represent the changing contraction pattern in the hypertensive patients, causing protrusion of the upper septum into left ventricular outflow track and may have a role in the genesis of systolic murmurs.
Tükek
Tufan
T
Istanbul University, Istanbul School of Medicine, Department of Internal Medicine, Turkey. Tufantukek@hotmail.com
Erdogan
Dogan
D
Tükek
Saliha Serap
SS
Akkaya
Vakur
V
Ozcan
Mustafa
M
D000368:Aged; D001783:Blood Flow Velocity; D003326:Coronary Circulation; D003331:Coronary Vessels / Q000502:physiology; D015150:Echocardiography, Doppler; D005260:Female; D006337:Heart Murmurs / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling