Diastolic Function Changes during Stress Echocardiography in Hypertensive Patients

Authors

1 Assistant Professor of Cardiology, Mashhad University of Medical sciences, Mashhad, Iran

2 North Khorasan University of Medical Sciences, Mashhad, Iran

3 Resident of Cardiology, Mashhad University of Medical sciences, Mashhad, Iran

4 Professor of Cardiology, Mashhad University of Medical sciences, Mashhad, Iran

5 Mashhad University of Medical sciences, Mashhad, Iran

6 Cardiovascular Research Center, Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Abstract Background: Some hypertensive patients experience dyspnea with exercise due to rise in filling pressures. So, exercise is helpful to determine left ventricular filling tension. Objectives: This study aims to evaluate the effect of dobutamine stress echocardiography on diastolic function in hypertensive patients with normal ejection fraction. Methods: In this study, 30 hypertensive patients (52.7  3.6 years) and 30 sex and age matched healthy controls (50.8  7.6 years) were examined. Exclusion criteria were patients with coronary artery disease, significant valvular heart disease, hypertrophic cardiomyopathy, left ventricular systolic dysfunction (EF (ejection fraction) < 50%), atrial fibrillation and bad echogenic view. We performed complete echocardiography and dobutamine stress echocardiography with pulsed wave Doppler tissue imaging at rest and during peak stress to measure primary mitral inflow diastolic wave rate (E), late mitral inflow diastolic wave rate (A), E/A ratio, primary diastolic myocardial wave rate (E0) and late diastolic myocardial wave velocity (A’). Results: At rest, E’ was significantly lower in patients than controls (8.21.6 vs 14.72.6 P value< 0.001) and E/E (early mitral inflow diastolic wave rate/early myocardial diastolic wave rate) was significantly higher in patients (7.61.2 vs 4.81.0 P value

Keywords

References

  1. 1.Burgess MI, Jenkins C, Sharman JE, Marwick TH. Diastolic stress echocardiography: hemodynamic validation and clinical significance of estimation of ventricular filling pressure with exercise. J Am Coll Cardiol. 2006;47(9):1891–900. doi: 10.1016/j.jacc.2006.02.042. [PubMed: 16682317].

    1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JJ, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42(6):1206–52. doi: 10.1161/01.HYP.0000107251.49515.c2. [PubMed: 14656957].
    2. Slama M, Susic D, Varagic J, Frohlich ED. Diastolic dysfunction in hypertension. Curr Opin Cardiol. 2002;17(4):368–73. [PubMed: 12151871].
    3. Ha JW, Lulic F, Bailey KR, Pellikka PA, Seward JB, Tajik AJ, et al. Effects of treadmill exercise on mitral inflow and annular velocities in healthy adults. Am J Cardiol. 2003;91(1):114–5. [PubMed: 12505590].
    4. Ha JW, Oh JK, Pellikka PA, Ommen SR, Stussy VL, Bailey KR, et al. Diastolic stress echocardiography: a novel noninvasive diagnostic test for diastolic dysfunction using supine bicycle exercise Doppler echocardiography. J Am Soc Echocardiogr. 2005;18(1):63–8. doi: 10.1016/j.echo.2004.08.033. [PubMed: 15637491].
    5. Wake R, Takeuchi M, Yoshitani H, Miyazaki C, Otani S, Yoshiyama M, et al. Role of contrast-enhanced dobutamine stress echocardiography in predicting outcome in patients with known or suspected coronary artery disease. Echocardiography. 2006;23(8):642–9. doi: 10.1111/j.1540- 8175.2006.00283.x. [PubMed: 16970715].
    6. von Bibra H, Tuchnitz A, Klein A, Schneider-Eicke J, Schomig A, Schwaiger M. Regional diastolic function by pulsed Doppler myocardial mapping for the detection of left ventricular ischemia during pharmacologic stress testing: a comparison with stress echocardiography and perfusion scintigraphy. J Am Coll Cardiol. 2000;36(2):444– 52.
    7. Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, et al. Heart disease and stroke statistics–2012 update: a report from the American Heart Association. Circulation. 2012;125(1):2–220. doi: 10.1161/CIR.0b013e31823ac046. [PubMed: 22179539].
    8. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, et al. Recommendations for chamber quantification: a report from the American Society of Echocardiography’s Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–63. doi: 10.1016/j.echo.2005.10.005. [PubMed: 16376782].
    9. Ommen SR, Nishimura RA. A clinical approach to the assessment of left ventricular diastolic function by Doppler echocardiography: update 2003. Heart. 2003;89 Suppl 3:iii18–23. [PubMed: 14594871].
    10. Chattopadhyay S, Alamgir MF, Nikitin NP, Rigby AS, Clark AL, Cleland JG. Lack of diastolic reserve in patients with heart failure and normal ejection fraction. Circ Heart Fail. 2010;3(1):35–43. doi: 10.1161/CIRCHEARTFAILURE.108.824888. [PubMed: 19850696].
    11. Becher H, Chambers J, Fox K, Jones R, Leech GJ, Masani N, et al. BSE procedure guidelines for the clinical application of stress echocardiography, recommendations for performance and interpretation of stress echocardiography: a report of the British Society of Echocardiography Policy Committee. Heart. 2004;90 Suppl 6:vi23–30. doi: 10.1136/hrt.2004.047985. [PubMed: 15564422]. 13. Lorell BH, Carabello BA. Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation. 2000;102(4):470–9. [PubMed: 10908222].
    12. Kitzman DW, Higginbotham MB, Cobb FR, Sheikh KH, Sullivan MJ. Exercise intolerance in patients with heart failure and preserved left ventricular systolic function: failure of the Frank-Starling mechanism. J Am Coll Cardiol. 1991;17(5):1065–72. [PubMed: 2007704].
    13. Maurer MS, Spevack D, Burkhoff D, Kronzon I. Diastolic dysfunction: can it be diagnosed by Doppler echocardiography?. J Am Coll Cardiol. 2004;44(8):1543–9. doi: 10.1016/j.jacc.2004.07.034. [PubMed: 15489083]. Razavi Int J Med. 2017; 5(2):e42876. 5 Hosseini S et al.
    14. Klapholz M, Maurer M, Lowe AM, Messineo F, Meisner JS, Mitchell J, et al. Hospitalization for heart failure in the presence of a normal left ventricular ejection fraction: results of the New York Heart Failure Registry. J Am Coll Cardiol. 2004;43(8):1432–8. doi: 10.1016/j.jacc.2003.11.040. [PubMed: 15093880].
    15. Zile MR, Baicu CF, Gaasch WH. Diastolic heart failure–abnormalities in active relaxation and passive stiffness of the left ventricle. N Engl J Med. 2004;350(19):1953–9. doi: 10.1056/NEJMoa032566. [PubMed: 15128895].
    16. Zile MR, Brutsaert DL. New concepts in diastolic dysfunction and diastolic heart failure: Part I: diagnosis, prognosis, and measurements of diastolic function. Circulation. 2002;105(11):1387–93. [PubMed: 11901053].
    17. Burkhoff D, Maurer MS, Packer M. Heart failure with a normal ejection fraction: is it really a disorder of diastolic function?. Circulation. 2003;107(5):656–8. [PubMed: 12578861].
    18. Vasan RS, Benjamin EJ, Levy D. Prevalence, clinical features and prognosis of diastolic heart failure: an epidemiologic perspective. J Am Coll Cardiol. 1995;26(7):1565–74. doi: 10.1016/0735-1097(95)00381-9. [PubMed: 7594087].
    19. Paulus W, Brutsaert D, Gillebert T, Rademarkers F, Sys S. Leite-moreira a. European study group on diastolic heart failure. How to diagnose diastolic heart failure. Eur Heart J. 1998;19(7):990–1003. 22. Nagueh SF, Middleton KJ, Kopelen HA, Zoghbi WA, Quinones MA. Doppler tissue imaging: a noninvasive technique for evaluation of left ventricular relaxation and estimation of filling pressures. J Am Coll Cardiol. 1997;30(6):1527–33. [PubMed: 9362412].
    20. Ommen SR, Nishimura RA, Appleton CP, Miller FA, Oh JK, Redfield MM, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: A comparative simultaneous Doppler-catheterization study. Circulation. 2000;102(15):1788–94. [PubMed: 11023933].
    21. Kasner M, Westermann D, Steendijk P, Gaub R, Wilkenshoff U, Weitmann K, et al. Utility of Doppler echocardiography and tissue Doppler imaging in the estimation of diastolic function in heart failure with normal ejection fraction: a comparative Doppler-conductance catheterization study. Circulation. 2007;116(6):637–47. doi: 10.1161/CIRCULATIONAHA.106.661983. [PubMed: 17646587]. 25. Verdecchia P, Schillaci G, Guerrieri M, Boldrini F, Gatteschi C, Benemio G, et al. Prevalence and determinants of left ventricular diastolic filling abnormalities in an unselected hypertensive population. Eur Heart J. 1990;11(8):679–91. [PubMed: 2144489].
    22. Brach C, Marin D, Kuntz S. Analysis of mitral annulus ex-cursion with tissue doppler. Echcardiography. 1999;88(8):353–62.
    23. Avdic S. , Mujcinovic Z. , Asceric M. , Nukic S. , Kusljugic Z. , Smajic E. . Left venticular diastolic dysfunction in essential hypertension. Bosnian J bas Med Sci. 2007;7(1):15–20.
    24. Kasner M, Sinning D, Lober J, Post H, Fraser AG, Pieske B, et al. Heterogeneous responses of systolic and diastolic left ventricular function to exercise in patients with heart failure and preserved ejection fraction. ESC Heart Fail. 2015;2(3):121–32. doi: 10.1002/ehf2.12049. [PubMed: 27708854]. 29. Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. J Am Soc Echocardiogr. 2009;22(2):107– 33. doi: 10.1016/j.echo.2008.11.023. [PubMed: 19187853].
    25. Lamb HJ, Beyerbacht HP, van der Laarse A, Stoel BC, Doornbos J, van der Wall EE, et al. Diastolic dysfunction in hypertensive heart disease is associated with altered myocardial metabolism. Circulation. 1999;99(17):2261–7. [PubMed: 10226091].
    26. Talreja D, Nishimura R. Noninvasive parameters of diastolic function reflect invasively measured filling pressures during exercise. Philadelphia, PA: Lippincott Williams and Wilkins 530 Walnut St; 2004.

Files

Share

How to cite

Statistics