Diastolic Function Changes during Stress Echocardiography in Hypertensive Patients

Authors

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

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

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

4 Mashhad University of Medical sciences, Mashhad, Iran

5 North Khorasan University of Medical Sciences, Mashhad, Iran

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

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 <0.001). At peak stress, E/A ratio was significantly lower in patients (P < 0.001) while E/E0 was significantly higher in patients than controls (8.32.1 vs 4.70.7 P value < 0.001).

Conclusions: Dobutamine stress echocardiography with Doppler tissue study is effective in the evaluation of hypertensive patients with dyspnea on exertion with normal resting echocardiography.

Keywords


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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. [PubMed: 16682317].
https://doi.org/10.1016/j.jacc.2006.02.042
PMid:16682317
 
2. 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. [PubMed: 14656957].
https://doi.org/10.1161/01.HYP.0000107251.49515.c2
PMid:14656957
 
3. Slama M, Susic D, Varagic J, Frohlich ED. Diastolic dysfunction in hypertension. Curr Opin Cardiol. 2002;17(4):368-73. [PubMed: 12151871].
https://doi.org/10.1097/00001573-200207000-00008
PMid:12151871
 
4. 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].
https://doi.org/10.1016/S0002-9149(02)03016-3
PMid:12505590
 
5. 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. [PubMed: 15637491].
https://doi.org/10.1016/j.echo.2004.08.033
PMid:15637491
 
6. 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. [PubMed: 16970715].
https://doi.org/10.1111/j.1540-8175.2006.00283.x
PMid:16970715
 
7. 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.
https://doi.org/10.1016/S0735-1097(00)00735-X
PMid:10933356
 
8. 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. [PubMed: 22179539].
 
9. 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. [PubMed: 16376782].
https://doi.org/10.1016/j.echo.2005.10.005
PMid:16376782
 
10. 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].
https://doi.org/10.1136/heart.89.suppl_3.iii18
PMid:14594871 PMCid:PMC1876299
 
11. 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. [PubMed: 19850696].
https://doi.org/10.1161/CIRCHEARTFAILURE.108.824888
PMid:19850696
 
12. 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. [PubMed: 15564422].
https://doi.org/10.1136/hrt.2004.047985
PMid:15564422 PMCid:PMC1876329
 
13. Lorell BH, Carabello BA. Left ventricular hypertrophy: pathogenesis, detection, and prognosis. Circulation. 2000;102(4):470-9. [PubMed: 10908222].
https://doi.org/10.1161/01.CIR.102.4.470
PMid:10908222
 
14. 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].
https://doi.org/10.1016/0735-1097(91)90832-T
PMid:2007704
 
15. 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. [PubMed: 15489083]. Razavi Int J Med. 2017; 5(2):e42876. 5 Hosseini S et al.
https://doi.org/10.1016/j.jacc.2004.07.034
PMid:15489083
 
16. 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. [PubMed: 15093880].
 
17. 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. [PubMed: 15128895].
https://doi.org/10.1056/NEJMoa032566
PMid:15128895
 
18. 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].
https://doi.org/10.1161/hc1102.105289
PMid:11901053
 
19. 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].
https://doi.org/10.1161/01.CIR.0000053947.82595.03
PMid:12578861
 
20. 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. [PubMed: 7594087].
https://doi.org/10.1016/0735-1097(95)00381-9
PMid:7594087
 
21. 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.
https://doi.org/10.1053/euhj.1998.1057
PMid:9717033
 
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].
https://doi.org/10.1016/S0735-1097(97)00344-6
PMid:9362412
 
23. 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].
https://doi.org/10.1161/01.CIR.102.15.1788
PMid:11023933
 
24. 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. [PubMed: 17646587].
https://doi.org/10.1161/CIRCULATIONAHA.106.661983
PMid: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].
https://doi.org/10.1093/oxfordjournals.eurheartj.a059783
PMid:2144489
 
26. Brach C, Marin D, Kuntz S. Analysis of mitral annulus ex-cursion with tissue doppler. Echcardiography. 1999;88(8):353-62.
https://doi.org/10.1007/s003920050297
PMid:10413858
 
27. 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.
https://doi.org/10.17305/bjbms.2007.3082
PMid:17489762 PMCid:PMC5802280
 
28. 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. [PubMed: 27708854].
https://doi.org/10.1002/ehf2.12049
PMid:27708854 PMCid:PMC5042029
 
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. [PubMed: 19187853].
https://doi.org/10.1016/j.echo.2008.11.023
PMid:19187853
 
30. 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].
https://doi.org/10.1161/01.CIR.99.17.2261
PMid:10226091
 
31. 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.