OR-8: A new technique for quantitative assessment of the heart in hypertension

The purpose of this study was to clarify diastolic function in the hypertensive heart by a newly developed echocardiographic technique, so called, strain rate imaging (SRI). Methods: A total of 111 consecutive patients (mean age 59 years, 50 male) with hypertension, excluding those with a history of coronary heart disease or renal impairment (serum creatinine > 1.5 mg/dl) underwent clinical and laboratory examinations and echocardiographic evaluations using an Aplio (Toshiba, Tokyo). Left atrial and left ventricular (LV) dimension were measured and usual LV parameters such as LV mass index (LVMI) and relative wall thickness (RWT: ratio of wall thickness/LV cavity radius) were calculated. Peak and late diastolic transmitral velocities (E- and A-velocity, respectively), and deceleration time of E-velocity (DcT) were also measured. Peak systolic and diastolic SRI (SRI-S, SRI-D, respectively) were obtained by tissue Doppler imaging. Serum creatinine and plasma brain natriuretic peptide (BNP) concentrations were also determined. Results: These subjects were divided into four groups; 42 normal LV (LVMI < 125 g/m2, RWT < 0.45), 12 LV remodeling (LVMI < 125 g/m2 and RWT > 0.45), 40 concentric LV hypertrophy (LVH) (LVMI > 125 g/m2 and RWT > 0.45), and 17 eccentric LVH (LVMI > 125 g/m2 and RWT < 0.45). Although mean age, serum creatinine, ejection fraction (EF), E-velocity, and SRI-S showed no significant difference among groups, plasma concentration of BNP, left atrial dimension, and A-velocity were significantly different among groups by an analysis of variance, and were significantly reduced in the concentric and eccentric LVH groups compared with the normal LV and LV remodeling groups by Turkey-HSD test. DcT was significantly reduced only in the concentric LVH group. In contrast, SRI-D was different among groups, but was significantly reduced only in the LV remodeling group compared with the other three groups (p < 0.05; -9.6 in normal LV, -6.6 in LV remodeling, -8.0 in concentric LVH, -8.5 in eccentric LVH). Conclusion: Global diastolic function was significantly reduced in the concentric and eccentric LVH groups, accompanied by an increase of plasma BNP concentration, but was preserved in the LV remodeling group. However, strain rate imaging detected regional abnormality of the left ventricle during the diastolic phase in the LV remodeling group with hypertension.